Bilateral whole knee arthroplasty could enhance threat of issues

Sufferers present process bilateral whole knee arthroplasty (TKA) are at an elevated threat of a number of varieties of issues, as in contrast with matched sufferers present process unilateral TKA, studies a examine in The Journal of Bone & Joint Surgical procedure. The journal is printed within the Lippincott portfolio in partnership with Wolters Kluwer.

“Sufferers who underwent simultaneous bilateral TKA have been at larger threat of experiencing postoperative issues akin to pulmonary embolism, stroke, blood loss anemia, and requiring a transfusion,” in response to the report by Nathanael D. Heckmann, MD, and colleagues of Keck Faculty of Medication of USC, Los Angeles.

Examine in matched teams of sufferers clarifies dangers of bilateral TKA

TKA is a extremely efficient remedy for sufferers with superior osteoarthritis of the knee, reducing ache and enhancing perform. When each knees are affected, bilateral TKA presents some benefits over sequential unilateral TKA, together with much less time within the hospital, a single rehabilitation interval, and decrease general prices.

Nevertheless, some research have discovered an elevated threat of issues, together with the next mortality charge, in sufferers present process bilateral TKA. These research have had vital limitations, together with a scarcity of affected person matching to account for potential variations between these present process bilateral versus unilateral TKA. To handle these points, Dr. Heckmann and colleagues in contrast issues and mortality in a big, nationally consultant group of sufferers present process bilateral versus unilateral TKA.

The evaluation included greater than 21,000 sufferers present process simultaneous bilateral TKA. These have been matched for age, intercourse, race, and comorbidities with a cohort of 126,000 sufferers present process unilateral TKA. After matching, the 2 teams had a median age of 64 years with related comorbidities. As all TKAS have been carried out between 2015 and 2020, the surgical procedures mirrored trendy orthopaedic apply.

Stroke, transfusion, and different dangers larger following bilateral TKA

Sufferers within the simultaneous bilateral TKA group had elevated charges of a number of varieties of issues in contrast with these within the unilateral TKA group, pulmonary embolism (0.27% versus 0.13%), stroke (0.13% versus 0.06%), and respiratory failure (0.46% versus 0.34%).

Sufferers present process bilateral TKA have been additionally at the next threat of anemia as a consequence of blood loss (26.89% versus 14.86%) and have been extra prone to endure a blood transfusion (5.23% versus 0.67%). These dangers have been elevated regardless of the excessive use of tranexamic acid to scale back blood loss throughout surgical procedure in each teams.

Sufferers present process bilateral TKA have been additionally extra prone to be readmitted to the hospital inside 90 days (2.80% versus 2.05%). There was no vital enhance within the threat of in-hospital dying (0.05% versus 0.04%).

After adjusting for confounders, the dangers of pulmonary embolism, stroke, and acute blood loss anemia have been roughly doubled within the bilateral TKA group, whereas the chance of blood transfusion was almost 9 occasions larger. The chance of readmission inside 90 days was 35% larger with bilateral in contrast with unilateral TKA.

“This examine presents the most important matched pattern measurement thus far evaluating the issues and security between sufferers handled with simultaneous bilateral TKA and people handled with unilateral TKA,” Dr. Heckmann and coauthors write. Though there was no vital distinction within the charge of in-hospital dying, “The chance of mortality following simultaneous bilateral TKA continues to be a subject of concern.” The researchers emphasize the necessity for affected person counseling and “thorough medical optimization” in sufferers chosen for bilateral TKA.