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Comparative Study
. 2008 Nov;466(11):2617-27.
doi: 10.1007/s11999-008-0402-5. Epub 2008 Aug 14.

In-hospital complications and mortality of unilateral, bilateral, and revision TKA: based on an estimate of 4,159,661 discharges

Stavros G Memtsoudis  1 , Alejandro González Della Valle, Melanie C Besculides, Licia Gaber, Thomas P Sculco
Affiliations
Comparative Study

In-hospital complications and mortality of unilateral, bilateral, and revision TKA: based on an estimate of 4,159,661 discharges

Stavros G Memtsoudis et al. Clin Orthop Relat Res. 2008 Nov.

Abstract

Patients undergoing bilateral total knee arthroplasty (BTKA) may have higher complication rates and mortality than those undergoing a unilateral procedure (UTKA). To evaluate this hypothesis, we analyzed nationally representative data collected for the National Hospital Discharge Survey on discharges after BTKA, UTKA, and revision TKA (RTKA) between 1990 and 2004. The demographics, comorbidities, in-hospital stay, complications, and mortality of each procedure were compared. An estimate of 4,159,661 discharges (153,259 BTKAs; 3,672,247 UTKAs; 334,155 RTKAs) were included. Patients undergoing BTKA were younger (1.5 years) and had a lower prevalence of comorbidities for hypertension (versus UTKA), diabetes, pulmonary disease, and coronary artery disease (versus UTKA and RTKA). The length of hospitalization was 5.8 days for BTKA, 5.3 for UTKA, and 5.4 for RTKA. Despite similar length of hospitalization, the prevalence of procedure-related complications was higher for BTKA (12.2%) compared with UTKA (8.2%) and RTKA (8.7%). In-hospital mortality was highest for patients undergoing BTKA (BTKA, 0.5%; UTKA, 0.3%; RTKA, 0.3%). Patients undergoing BTKA had a 1.6 times higher rate of procedure-related complications and mortality compared with those undergoing UTKA. Outcomes for patients undergoing RTKA for most variables were similar to those for UTKA. BTKA, advanced age, and male gender were independent risk factors for complications and mortality after TKA.

Level of evidence: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Figures

Fig. 1
Fig. 1
The figure shows the prevalence of comorbidities among patients undergoing different types of TKA procedures. The p value is less than 0.001 among all procedure types for all comorbidity groups (z-scores), except pulmonary (UTKA and BTKA and BTKA and RTKA only) and hypercholesteremia (UTKA and RTKA and BTKA and RTKA only). UTKA = unilateral TKA; BTKA = bilateral TKA; RTKA = revision TKA.
Fig. 2
Fig. 2
The figure shows the prevalence of selected adverse diagnoses among patients undergoing different types of TKA. ARDS = pulmonary insufficiency after trauma or surgery/ARDS. The p value is less than 0.001 between all procedure types for all adverse event groups (z-scores), except for ARDS (UTKA and RTKA and BTKA and RTKA only). UTKA = unilateral TKA; RTKA = revision TKA; BTKA = bilateral TKA.
Fig. 3
Fig. 3
The figure shows the discharge destination after different TKA procedures. The p value is less than 0.001 among all procedure types (chi square) and among discharge destination groups (z-scores). UTKA = unilateral TKA; BTKA = bilateral TKA; RTKA = revision TKA.
Fig. 4
Fig. 4
The figure shows the odds ratios (ORs) and 95% confidence intervals (95% CIs) for in-hospital mortality and selected medical complications in patients undergoing BTKA and RTKA. (Referent is UTKA; OR, 1.) All ORs are different from UTKA = 1. BTKA = bilateral TKA; RTKA = revision TKA; UTKA = unilateral TKA.
See this image and copyright information in PMC

References

    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1054/arth.2001.21495', 'is_inner': False, 'url': 'https://doi.org/10.1054/arth.2001.21495'}, {'type': 'PubMed', 'value': '11307122', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/11307122/'}]}
    2. 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;16:271–278. - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'PubMed', 'value': '12539940', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/12539940/'}]}
    2. Alemparte J, Johnson GV, Worland RL, Jessup DE, Keenan J. Results of simultaneous bilateral total knee replacement: a study of 1208 knees in 604 patients. J South Orthop Assoc. 2002;11:153–156. - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1302/0301-620X.88B10.17697', 'is_inner': False, 'url': 'https://doi.org/10.1302/0301-620x.88b10.17697'}, {'type': 'PubMed', 'value': '17012421', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/17012421/'}]}
    2. Amin AK, Clayton RA, Patton JT, Gaston M, Cook RE, Brenkel IJ. Total knee replacement in morbidly obese patients. Results of a prospective, matched study. J Bone Joint Surg Br. 2006;88:1321–1326. - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.2106/JBJS.E.01323', 'is_inner': False, 'url': 'https://doi.org/10.2106/jbjs.e.01323'}, {'type': 'PubMed', 'value': '17015590', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/17015590/'}]}
    2. 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;88:2146–2151. - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1007/BF00379942', 'is_inner': False, 'url': 'https://doi.org/10.1007/bf00379942'}, {'type': 'PubMed', 'value': '6882167', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/6882167/'}]}
    2. Besser MI. Bilateral Attenborough total knee replacement as a single procedure. Arch Orthop Trauma Surg. 1983;101:271–272. - PubMed

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