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. 2024 Mar 18;15(3):230-237.
doi: 10.5312/wjo.v15.i3.230.

Subsequent total joint arthroplasty: Are we learning from the first stage?

Christine Jiang Wu  1 , Colin Penrose  2 , Sean Patrick Ryan  3 , Michael Paul Bolognesi  3 , Thorsten Markus Seyler  3 , Samuel Secord Wellman  3
Affiliations

Subsequent total joint arthroplasty: Are we learning from the first stage?

Christine Jiang Wu et al. World J Orthop. .

Abstract

Background: With the increasing incidence of total joint arthroplasty (TJA), there is a desire to reduce peri-operative complications and resource utilization. As degenerative conditions progress in multiple joints, many patients undergo multiple procedures.

Aim: To determine if both physicians and patients learn from the patient's initial arthroplasty, resulting in improved outcomes following the second procedure.

Methods: The institutional database was retrospectively queried for primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). Patients with only unilateral THA or TKA, and patients undergoing same-day bilateral TJA, were excluded. Patient demographics, comorbidities, and implant sizes were collected at the time of each procedure and patients were stratified by first vs second surgery. Outcome metrics evaluated included operative time, length of stay (LOS), disposition, 90-d readmissions and emergency department (ED) visits.

Results: A total of 642 patients, including 364 undergoing staged bilateral TKA and 278 undergoing bilateral THA, were analyzed. There was no significant difference in demographics or comorbidities between the first and second procedure, which were separated by a mean of 285 d. For THA and TKA, LOS was significantly less for the second surgery, with 66% of patients having a shorter hospitalization (P < 0.001). THA patients had significantly decreased operative time only when the same sized implant was utilized (P = 0.025). The vast majority (93.3%) of patients were discharged to the same type of location following their second surgery. However, when a change in disposition was present from the first surgery, patients were significantly more likely to be discharged to home after the second procedure (P = 0.033). There was no difference between procedures for post-operative readmissions (P = 0.438) or ED visits (P = 0.915).

Conclusion: After gaining valuable experience recovering from the initial surgery, a patient's perioperative outcomes are improved for their second TJA. This may be the result of increased confidence and decreased anxiety, and it supports the theory that enhanced patient education pre-operatively may improve outcomes. For the surgical team, the second procedure of a staged THA is more efficient, although this finding did not hold for TKA.

Keywords: Asynchronous total joint arthroplasty; Contralateral total joint arthroplasty; Perioperative outcomes; Staged total joint arthroplasty; Subsequent total joint arthroplasty.

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Conflict of interest statement

Conflict-of-interest statement: Colin Penrose and Christine Jiang Wu report no conflicts. Sean Patrick Ryan reports research support from Zimmer Biomet and Smith & Nephew, outside the submitted work. Michael Paul Bolognesi reports royalties from Total Joint Orthopaedics and Zimmer Biomet, stock options from Amedica, research support from Depuy Synthes, Exactech, PCORI, and financial support from Smith & Nephew, DJO, and Acelity, and research support from KCI, outside of this work. Thorsten Markus Seyler reports paid consultant work from Total Joint Orthopedics, Smith & Nephew, Heraeus Medical, and Peptilogics, research support from Zimmer Biomet, Royalties from Pattern Health, publishing royalties from Lippincott Williams & Wilkins, and IP royalties from Restor3d, outside the submitted work. Samuel Secord Wellman reports research support from Zimmer Biomet and DePuy Synthes, stock options from Joint Development, LLC, research support from Medacta, Smith & Nephew, Stryker, and royalties from Joint Orthopedics, outside the submitted work.

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References

    1. Pabinger C, Geissler A. Utilization rates of hip arthroplasty in OECD countries. Osteoarthritis Cartilage. 2014;22:734–741. - PubMed
    1. Pabinger C, Lothaller H, Geissler A. Utilization rates of knee-arthroplasty in OECD countries. Osteoarthritis Cartilage. 2015;23:1664–1673. - PubMed
    1. Sloan M, Premkumar A, Sheth NP. Projected Volume of Primary Total Joint Arthroplasty in the U.S., 2014 to 2030. J Bone Joint Surg Am. 2018;100:1455–1460. - PubMed
    1. Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89:780–785. - PubMed
    1. Singh JA, Yu S, Chen L, Cleveland JD. Rates of Total Joint Replacement in the United States: Future Projections to 2020-2040 Using the National Inpatient Sample. J Rheumatol. 2019;46:1134–1140. - PubMed