Simultaneous vs staged bilateral total knee arthroplasty: a propensity-matched case-control study from nine fast-track centres

TY - JOUR

T1 - Simultaneous vs staged bilateral total knee arthroplasty

T2 - a propensity-matched case-control study from nine fast-track centres

AU - Lindberg-Larsen, M.

AU - Pitter, F. T.

AU - Husted, H.

AU - Kehlet, H.

AU - Jørgensen, C. C.

AU - Lundbeck Foundation Centre for Fast-Track Hip and Knee Replacement Collaborative Group

PY - 2019/5/1

Y1 - 2019/5/1

N2 - INTRODUCTION: Limited data exist on patient safety after simultaneous vs staged bilateral total knee arthroplasty (TKA) in matched groups. Hence, the aim of this study was to compare length of stay (LOS), in-hospital complications, 30-day readmissions and mortality after simultaneous and staged bilateral TKA in matched patients.PATIENTS AND METHODS: A retrospective case-control study of prospectively collected data in nine centres from February 2010 to November 2015. Propensity scores (PS) were used to match simultaneous and staged (1-6 months between stages) bilateral TKA patients with prospectively collected patient characteristics from the Lundbeck Foundation Centre for Fast-track THA and TKA Database. 30-day follow-up was acquired from the Danish Patient Registry and patient records.RESULTS: A total of 344 (47.1%) simultaneous and 386 (52.9%) staged bilateral TKA procedures were performed. PS matching was possible in 232 simultaneous and 232 staged bilateral TKA patients. LOS was median 4 days (IQR 3-5) after simultaneous and cumulated 4 days (IQR 4-6) after staged procedures. The in-hospital complication rate was 15.5% after simultaneous vs 7.3% (p = 0.004) after staged procedures. Two cases (0.9%) of venous thromboembolic events were found in each group. Eight patients (3.4%) were re-operated after simultaneous vs one patient (0.4%) after staged bilateral TKA (p = 0.037). The 30-day readmission rate was 8.6% after simultaneous vs 5.6% after staged procedures (p = 0.281). No patients died in either group.CONCLUSIONS: We found no significant differences in 30-day readmission rates and mortality between simultaneous and staged bilateral TKA, but the in-hospital complication rate and re-operation rate was higher after the simultaneous procedure calling for further matched investigations in larger cohorts.

AB - INTRODUCTION: Limited data exist on patient safety after simultaneous vs staged bilateral total knee arthroplasty (TKA) in matched groups. Hence, the aim of this study was to compare length of stay (LOS), in-hospital complications, 30-day readmissions and mortality after simultaneous and staged bilateral TKA in matched patients.PATIENTS AND METHODS: A retrospective case-control study of prospectively collected data in nine centres from February 2010 to November 2015. Propensity scores (PS) were used to match simultaneous and staged (1-6 months between stages) bilateral TKA patients with prospectively collected patient characteristics from the Lundbeck Foundation Centre for Fast-track THA and TKA Database. 30-day follow-up was acquired from the Danish Patient Registry and patient records.RESULTS: A total of 344 (47.1%) simultaneous and 386 (52.9%) staged bilateral TKA procedures were performed. PS matching was possible in 232 simultaneous and 232 staged bilateral TKA patients. LOS was median 4 days (IQR 3-5) after simultaneous and cumulated 4 days (IQR 4-6) after staged procedures. The in-hospital complication rate was 15.5% after simultaneous vs 7.3% (p = 0.004) after staged procedures. Two cases (0.9%) of venous thromboembolic events were found in each group. Eight patients (3.4%) were re-operated after simultaneous vs one patient (0.4%) after staged bilateral TKA (p = 0.037). The 30-day readmission rate was 8.6% after simultaneous vs 5.6% after staged procedures (p = 0.281). No patients died in either group.CONCLUSIONS: We found no significant differences in 30-day readmission rates and mortality between simultaneous and staged bilateral TKA, but the in-hospital complication rate and re-operation rate was higher after the simultaneous procedure calling for further matched investigations in larger cohorts.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Arthroplasty, Replacement, Knee/adverse effects

KW - Case-Control Studies

KW - Clinical Protocols/standards

KW - Databases, Factual

KW - Female

KW - Humans

KW - Length of Stay

KW - Male

KW - Middle Aged

KW - Osteoarthritis, Knee/surgery

KW - Patient Readmission

KW - Perioperative Care/standards

KW - Propensity Score

KW - Registries

KW - Reoperation

KW - Retrospective Studies

KW - Time Factors

U2 - 10.1007/s00402-019-03157-z

DO - 10.1007/s00402-019-03157-z

M3 - Journal article

C2 - 30840128

SN - 0936-8051

VL - 139

SP - 709

EP - 716

JO - Archives of Orthopaedic and Trauma Surgery

JF - Archives of Orthopaedic and Trauma Surgery

IS - 5

ER -