Download PDF
J Knee Surg 2021; 34(14): 1579-1586
DOI: 10.1055/s-0040-1712100
Original Article

Should Sequential Bilateral Total Knee Arthroplasty Be Limited to Patients Younger than 80? A Two-Arm Propensity Matched Study

Antonio Klasan 
1   Sydney Orthopaedic Research Institute, Chatswood, New South Wales, Australia
,
Sven Edward Putnis 
1   Sydney Orthopaedic Research Institute, Chatswood, New South Wales, Australia
,
Wai Weng Yeo
2   Department of Medicine, University of New South Wales, Sydney, Australia
,
Darli Myat
1   Sydney Orthopaedic Research Institute, Chatswood, New South Wales, Australia
,
Brett Andrew Fritsch
1   Sydney Orthopaedic Research Institute, Chatswood, New South Wales, Australia
,
Myles Raphael Coolican
1   Sydney Orthopaedic Research Institute, Chatswood, New South Wales, Australia
,
David Anthony Parker
1   Sydney Orthopaedic Research Institute, Chatswood, New South Wales, Australia
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

Despite multiple studies, there remains a debate on the safety of bilateral total knee arthroplasty (BTKA) in the average age patient, with a paucity of data on the outcome of BTKA in an elderly population. This study included 89 patients aged 80 years and older undergoing sequential BTKA over 14 years were identified in a prospectively collected database. Two matched comparison groups were created: patients under 80 undergoing sequential BTKA and patients over 80 undergoing unilateral TKA (UTKA). An analysis of complications, mortality, revision, and patient-reported outcome measures was performed. Mean age of the elderly cohorts was similar: 82.6 for BTKA and 82.9 for UTKA. The average age BTKA cohort had a mean age of 69.1. Complication rates were higher in bilateral cohorts, more so in the elderly BTKA cohort. Pulmonary embolism (PE) was observed in bilateral cohorts only. In these patients, history of PE and ischemic heart disease was a strong predictive factor for developing a major complication. There was no difference in revision rates and infection rates between the three cohorts, and no difference in patient survivorship between the two elderly cohorts. Through the combination of low revision and high survivorship rates and comparable clinical outcomes, this article demonstrates that simultaneous BTKA is an appropriate option to consider for an elderly patient, with proper patient selection and perioperative management. The demonstrated risk groups show that emphasis on patient selection should be focused on medical history rather than chronological age.

Keywords

knee - arthroplasty - bilateral - elderly - complications - survivorship


Publication History

Received: 05 June 2019

Accepted: 31 March 2020

Article published online:
25 May 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Centers for Disease Control and Prevention (CDC). Prevalence of disabilities and associated health conditions among adults--United States, 1999. MMWR Morb Mortal Wkly Rep 2001; 50 (07) 120-125
    PubMedGoogle Scholar
  • 2 Murphy L, Schwartz TA, Helmick CG. et al. Lifetime risk of symptomatic knee osteoarthritis. Arthritis Rheum 2008; 59 (09) 1207-1213
    CrossrefPubMedGoogle Scholar
  • 3 Koh WU, Kim H-J, Park H-S, Jang M-J, Ro Y-J, Song J-G. Staggered rather than staged or simultaneous surgical strategy may reduce the risk of acute kidney injury in patients undergoing bilateral TKA. J Bone Joint Surg Am 2018; 100 (18) 1597-1604
    CrossrefPubMedGoogle Scholar
  • 4 Kulshrestha V, Kumar S, Datta B, Sinha VK, Mittal G. Ninety-day morbidity and mortality in risk-screened and optimized patients undergoing two-team fast-track simultaneous bilateral TKA compared with unilateral TKA-A prospective study. J Arthroplasty 2018; 33 (03) 752-760
    CrossrefPubMedGoogle Scholar
  • 5 Restrepo C, Parvizi J, Dietrich T, Einhorn TA. Safety of simultaneous bilateral total knee arthroplasty. A meta-analysis. J Bone Joint Surg Am 2007; 89 (06) 1220-1226
    CrossrefPubMedGoogle Scholar
  • 6 Parvizi J, Rasouli MR. Simultaneous-bilateral TKA: double trouble - affirms. J Bone Joint Surg Br 2012; 94 (11) , Suppl A ): 90-92
    CrossrefPubMedGoogle Scholar
  • 7 Sculco TP, Sculco PK. Simultaneous-bilateral TKA: double trouble - opposes. J Bone Joint Surg Br 2012; 94 (11) , Suppl A ); 93-94
    CrossrefPubMedGoogle Scholar
  • 8 Suleiman LI, Edelstein AI, Thompson RM, Alvi HM, Kwasny MJ, Manning DW. Perioperative outcomes following unilateral versus bilateral total knee arthroplasty. J Arthroplasty 2015; 30 (11) 1927-1930
    CrossrefPubMedGoogle Scholar
  • 9 Passias PG, Bono OJ, Bono JV. Total knee arthroplasty in patients of advanced age: a look at outcomes and complications. J Knee Surg 2020; 33 (01) 1-7
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 Lindberg-Larsen M, Jørgensen CC, Husted H, Kehlet H. Early morbidity after simultaneous and staged bilateral total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2015; 23 (03) 831-837
    CrossrefPubMedGoogle Scholar
  • 11 Odum SM, Troyer JL, Kelly MP, Dedini RD, Bozic KJ. A cost-utility analysis comparing the cost-effectiveness of simultaneous and staged bilateral total knee arthroplasty. J Bone Joint Surg Am 2013; 95 (16) 1441-1449
    CrossrefPubMedGoogle Scholar
  • 12 Sheth DS, Cafri G, Paxton EW, Namba RS. Bilateral simultaneous vs staged total knee arthroplasty: a comparison of complications and mortality. J Arthroplasty 2016; 31 (09) 212-216
    CrossrefPubMedGoogle Scholar
  • 13 Kim Y-H, Choi Y-W, Kim J-S. Simultaneous bilateral sequential total knee replacement is as safe as unilateral total knee replacement. J Bone Joint Surg Br 2009; 91 (01) 64-68
    CrossrefPubMedGoogle Scholar
  • 14 Fu D, Li G, Chen K, Zeng H, Zhang X, Cai Z. Comparison of clinical outcome between simultaneous-bilateral and staged-bilateral total knee arthroplasty: a systematic review of retrospective studies. J Arthroplasty 2013; 28 (07) 1141-1147
    CrossrefPubMedGoogle Scholar
  • 15 Mangaleshkar SR, Prasad PS, Chugh S, Thomas AP. Staged bilateral total knee replacement--a safer approach in older patients. Knee 2001; 8 (03) 207-211
    CrossrefPubMedGoogle Scholar
  • 16 Lynch NM, Trousdale RT, Ilstrup DM. Complications after concomitant bilateral total knee arthroplasty in elderly patients. Mayo Clin Proc 1997; 72 (09) 799-805
    CrossrefPubMedGoogle Scholar
  • 17 Odum SM, Springer BD. In-hospital complication rates and associated factors after simultaneous bilateral versus unilateral total knee arthroplasty. J Bone Joint Surg Am 2014; 96 (13) 1058-1065
    CrossrefPubMedGoogle Scholar
  • 18 Abram SGF, Nicol F, Spencer SJ. Patient reported outcomes in three hundred and twenty eight bilateral total knee replacement cases (simultaneous versus staged arthroplasty) using the Oxford Knee Score. Int Orthop 2016; 40 (10) 2055-2059
    CrossrefPubMedGoogle Scholar
  • 19 Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240 (02) 205-213
    CrossrefPubMedGoogle Scholar
  • 20 Memtsoudis SG, Ma Y, González Della Valle A. et al. Perioperative outcomes after unilateral and bilateral total knee arthroplasty. Anesthesiology 2009; 111 (06) 1206-1216
    CrossrefPubMedGoogle Scholar
  • 21 Dawson J, Fitzpatrick R, Murray D, Carr A. Questionnaire on the perceptions of patients about total knee replacement. J Bone Joint Surg Br 1998; 80 (01) 63-69
    CrossrefPubMedGoogle Scholar
  • 22 Meehan JP, Monazzam S, Miles T, Danielsen B, White RH. Postoperative stiffness requiring manipulation under anesthesia is significantly reduced after simultaneous versus staged bilateral total knee arthroplasty. J Bone Joint Surg Am 2017; 99 (24) 2085-2093
    CrossrefPubMedGoogle Scholar
  • 23 Berend KR, Morris MJ, Skeels MD, Lombardi Jr AV, Adams JB. Perioperative complications of simultaneous versus staged unicompartmental knee arthroplasty. Clin Orthop Relat Res 2011; 469 (01) 168-173
    CrossrefPubMedGoogle Scholar
  • 24 Life, Tables, States, Territories, 2014–2016. Australian Bureau of Statistics. Accessed November 3, 2018 at: http://www.abs.gov.au/AUSSTATS/subscriber.nsf/log?openagent&3302055001do001_20152017.xls&3302.0.55.001&Data%20Cubes&5E3AFC114C86F682CA25833500134E5C&0&2015-2017&30.10.2018&Latest
  • 25 Barrett J, Baron JA, Losina E, Wright J, Mahomed NN, Katz JN. Bilateral total knee replacement: staging and pulmonary embolism. J Bone Joint Surg Am 2006; 88 (10) 2146-2151
    PubMedGoogle Scholar
  • 26 Seo JG, Kim SM, Shin JM, Kim Y, Lee BH. Safety of simultaneous bilateral total knee arthroplasty using an extramedullary referencing system: results from 2098 consecutive patients. Arch Orthop Trauma Surg 2016; 136 (11) 1615-1621
    CrossrefPubMedGoogle Scholar
  • 27 Cote MP, Chen A, Jiang Y, Cheng V, Lieberman JR. Persistent pulmonary embolism rates following total knee arthroplasty even with prophylactic anticoagulants. J Arthroplasty 2017; 32 (12) 3833-3839
    CrossrefPubMedGoogle Scholar
  • 28 Putnis SE, Klasan A, Redgment JD, Daniel MS, Parker DA, Coolican MRJ. One-stage sequential bilateral total knee arthroplasty: an effective treatment for advanced bilateral knee osteoarthritis providing high patient satisfaction. J Arthroplasty 2020; 35 (02) 401-406
    CrossrefPubMedGoogle Scholar
  • 29 Gurunathan U. Perioperative considerations of bilateral total knee replacement: a review. J Clin Anesth 2013; 25 (03) 232-239
    CrossrefPubMedGoogle Scholar
  • 30 Qi Y, Tie K, Wang H. et al. Perioperative comparison of blood loss and complications between simultaneous bilateral and unilateral total knee arthroplasty for knee osteoarthritis. Knee 2017; 24 (06) 1422-1427
    CrossrefPubMedGoogle Scholar
  • 31 Townsend LA, Roubion RC, Bourgeois DM. et al. Impact of age on patient-reported outcome measures in total knee arthroplasty. J Knee Surg 2018; 31 (06) 580-584
    Article in Thieme ConnectPubMedGoogle Scholar
  • 32 Sesen H, Demirkale I, Karaduman M, Vural CA, Okkaoglu MC, Altay M. Why two-thirds of patients accepted the second session in staged bilateral total knee arthroplasty: a prospective analysis of 111 patients. Knee Surg Sports Traumatol Arthrosc 2015; 23 (12) 3585-3590
    CrossrefPubMedGoogle Scholar
  • 33 Murphy BPD, Dowsey MM, Spelman T, Choong PFM. The impact of older age on patient outcomes following primary total knee arthroplasty. Bone Joint J 2018; 100-B (11) 1463-1470
    CrossrefPubMedGoogle Scholar
  • 34 Gu A, Wu S, Mancino F. et al. Impact of chronic obstructive pulmonary disease on postoperative complications following simultaneous bilateral total knee arthroplasty. J Knee Surg 2019; (August): DOI: 10.1055/s-0039-1695766.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 35 Pua Y-H, Seah FJ-T, Poon CL-L. et al. Age- and sex-based recovery curves to track functional outcomes in older adults with total knee arthroplasty. Age Ageing 2018; 47 (01) 144-148
    CrossrefPubMedGoogle Scholar
  • 36 Harato K, Kobayashi S, Kojima I, Sakurai A, Tanikawa H, Niki Y. Factors affecting one-leg standing time in patients with end-stage knee osteoarthritis and the age-related recovery process following total knee arthroplasty. J Orthop Surg Res 2017; 12 (01) 21
    CrossrefPubMedGoogle Scholar
  • 37 Dimitris CN, Taylor BC, Mowbray JG, Steensen RN, Gaines ST. Perioperative morbidity and mortality of 2-team simultaneous bilateral total knee arthroplasty. Orthopedics 2011; 34 (12) e841-e846
    CrossrefPubMedGoogle Scholar
  • 38 Sobh AH, Siljander MP, Mells AJ, Koueiter DM, Moore DD, Karadsheh MS. Cost analysis, complications, and discharge disposition associated with simultaneous vs staged bilateral total knee arthroplasty. J Arthroplasty 2018; 33 (02) 320-323
    CrossrefPubMedGoogle Scholar
  • 39 Liu L, Liu H, Zhang H, Song J, Zhang L. Bilateral total knee arthroplasty: Simultaneous or staged? A systematic review and meta-analysis. Medicine (Baltimore) 2019; 98 (22) e15931
    Google Scholar
  • 40 Adili A, Bhandari M, Petruccelli D, De Beer J. Sequential bilateral total knee arthroplasty under 1 anesthetic in patients > or = 75 years old: complications and functional outcomes. J Arthroplasty 2001; 16 (03) 271-278
    CrossrefPubMedGoogle Scholar
  • 41 Australian Orthopaedic Association National Joint Replacement Registry 2018 Supplementary Report. Australian Orthopaedic Association;33. Accessed November 5, 2018 at: https://aoanjrr.sahmri.com/documents/10180/578729/Demographics%20of%20Hip%20Knee%20and%20Shoulder%20Arthroplasty