Unilateral Total Knee Arthroplasty Group Research Articles

Risk factors for contralateral total knee arthroplasty after unilateral total knee arthroplasty

BackgroundLittle attention has been focused on risk factors for undergoing bilateral total knee arthroplasty (TKA) after primary unilateral TKA among patients with knee osteoarthritis (OA). This study investigated the differences in characteristics between groups with and without additional TKA for the contralateral knee among patients with knee OA who underwent primary unilateral TKA. MethodsSeventy-six patients who underwent primary unilateral TKA were included in this study. We defined patients who underwent additional TKA for the contralateral knee within one year of the primary TKA as a bilateral TKA group, and patients who did not undergo bilateral TKA as a unilateral TKA group. Femorotibial angle (FTA), percentage of mechanical axis (%MA), Kellgren–Lawrence (KL) grade, range of motion, Japan Orthopaedic Association (JOA) score, 10 m-walking time, C-reactive protein, estimated glomerular filtration rate, and serum albumin levels were selected as independent variables including covariates of age, sex, and body mass index for predicting bilateral TKA. We compared differences in variables between the two groups using the t-test or Mann–Whitney U-test and general linear models. A multivariate stepwise logistic regression model was also used to determine which variables correlated with bailateral TKA. ResultsIn pairwise comparisons, the KL grade, FTA, %MA, JOA score, and knee flexion angle in the contralateral knee were significantly worse in the bilateral TKA group than in the unilateral TKA group after controlling for covariates (P < 0.01, respectively). A stepwise logistic regression revealed that significant contributors to undergoing the contralateral TKA were FTA (OR = 1.47, P < 0.001) and knee flexion angle (OR = 0.96, P = 0.022) of the contralateral knee. ConclusionsSevere varus deformity and limitations of flexion in the contralateral knee were found to be risk factors for undergoing additional TKA within one year of primary unilateral TKA among patients with knee OA.

Should we use similar perioperative protocols in patients undergoing unilateral and bilateral one-stage total knee arthroplasty?

BACKGROUNDBilateral one-stage total knee arthroplasty (BTKA) is now in greater use as an alternative option for patients with bilateral end-stage knee arthropathy. However, postoperative pain and disablement during convalescence from BTKA, and procedure-related complications have been concerning issues for patients and surgeons. Although some studies reported that BTKA in selected patients is as safe as the staged procedure, well-defined guidelines for patient screening, and perioperative care and monitoring to avoid procedure-related complications are still controversial.AIMTo compare the perioperative outcomes including perioperative blood loss (PBL), cardiac biomarkers, pain intensity, functional recovery, and complications between unilateral total knee arthroplasty (UTKA) and BTKA performed with a similar perioperative protocol. METHODSWe conducted a retrospective study on consecutive patients undergoing UTKA and BTKA that had been performed by a single surgeon with identical perioperative protocols. The exclusion criteria of this study included patients with an American Society of Anesthesiologists score > 3, and known cardiopulmonary comorbidity or high-sensitivity Troponin-T (hs-TnT) > 14 ng/L. Outcome measures included visual analogue scale (VAS) score of postoperative pain, morphine consumption, range of knee motion, straight leg raise (SLR), length of stay (LOS), and serum hemoglobin (Hb) and hs-TnT monitored during hospitalization. RESULTSOf 210 UTKA and 137 BTKA patients, those in the BTKA group were younger and more predominately female. The PBL of the UTKA vs BTKA group was 646.45 ± 272.26 mL vs 1012.40 ± 391.95 mL (P < 0.01), and blood transfusion rates were 10.48% and 40.88% (P < 0.01), respectively. Preoperative Hb and body mass index were predictive factors for blood transfusion in BTKA, whereas preoperative Hb was only a determinant in UTKA patients. The BTKA group had significantly higher VAS scores than the UTKA group at 48, 72, and 96 h after surgery, and also had a significantly lower degree of SLR at 72 h. The BTKA group also had a significantly longer LOS than the UTKA group. Of the patients who had undergone the procedure, 5.71% of the UTKA patients and 12.41% of the BTKA patients (P = 0.04) had hs-TnT > 14 ng/L during the first 72 h postoperatively. However, there was no difference in other outcome measures and complications. CONCLUSIONFollowing similar perioperative management, the blood transfusion rate in BTKA is 4-fold that required in UTKA. Also, BTKA is associated with higher pain intensity at 48 h postoperatively and prolonged LOS when compared to the UTKA. Hence, BTKA patients may require more extensive perioperative management for blood loss and pain, even if having no higher risk of complications than UTKA.

Unicompartmental knee arthroplasty results in a better gait pattern than total knee arthroplasty: Gait analysis with a smartphone application.

Objectives The aim of this study was to compare the smartphone- based gait analysis data of patients who underwent total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA).Patients and methods Between January 2016 and April 2019, a total of 51 patients (3 males, 48 females; mean age: 60.92 years; range, 51 to 70 years) who were operated with UKA or TKA in our clinic were retrospectively analyzed. The patients were divided into two groups according to the type of procedure as the UKA group (n=17) and unilateral TKA group (n=34). Gait analysis was made via a smartphone application (Gait Analyzer software version 0.9.95.0) with data acquired from the accelerometer of the smartphone. This analysis was performed using data collected from the Acceleration Sensor LSM6DSO into the Samsung Galaxy Note 10 Plus phone. Gait velocity, step time, step length, cadence, step time symmetry, step length symmetry, and vertical COM (vert-COM) parameters were measured.Results There were no statistically significant differences between the groups in respect of age, sex, body mass index, operated side, and follow-up duration. Compared to the TKA group, the UKA patients showed a better gait pattern in gait velocity (p=0.03), step time symmetry (p=0.005), and step length symmetry (p=0.024). No significant difference was detected in step time (p=0.807), step length (p=0.302), cadence (p=0.727) and vert-COM parameters (p=0.608).Conclusion The gait of UKA patients is closer to the physiological pattern with a better gait velocity, step time symmetry, and step length symmetry than TKA patients. The surgical treatment option of UKA for knee medial compartment osteoarthritis leads to a better gait pattern than TKA.

Safety and efficacy of sequential simultaneous bilateral total knee arthroplasty: A single centre retrospective cohort study

BackgroundSimultaneous bilateral total knee arthroplasty (TKA) is a promising option for patients with bilateral arthritis of the knee because of the requirement of a single hospitalization and anesthetic regimen, reduced overall hospital stay, lower overall costs, and quicker recovery compared to staged bilateral TKA. However, there are conflicting reports on the safety of the procedure, with little data available in the Indian setting. Herein, we compared the efficacy and safety of sequential simultaneous bilateral TKA (SSBTKA) with those of unilateral TKA (UTKA). MethodsThis retrospective analysis included cases of SSBTKA (n = 380, 760 knees) and UTKA (n = 754) performed by the same surgeon and followed up for a minimum duration of 1 year. The functional outcomes (postoperative changes in Oxford Knee Score [OKS] and Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]), length of hospital stay (LOS), complications, and rates of revision and mortality were compared between the two groups. ResultsThe mean follow-up durations were 40.59 and 36.69 months for the UTKA and SSBTKA groups, respectively. The LOS was significantly longer in the SSBTKA group than in the UTKA group (Median [Interquartile range]: 4[1] vs. 3[0], p < 0.001). The OKS and WOMAC scores increased with time in both groups. The improvements in each of these scores at 3, 6, and 12 months postoperatively were either statistically similar between the two groups or, if statistically different, the differences were too small to be clinically meaningful. Blood transfusions (4% [SSBTKA] vs.0.3% [UTKA], p < 0.001), cardiac complications (1.6% vs. 0.4%, p = 0.034), urine retention (3.7% vs. 1.2%, p = 0.005), and deep infection (0.8% vs. 0%, p = 0.015) were significantly more frequent in the SSBTKA group. None of the patients in the UTKA group had to undergo revision surgery, whereas in the SSBTKA group, 2 (0.6%) patients underwent revision TKA. The overall mortality rates were low in both groups (0.8% [SSBTKA] and 0.3% [UTKA]), with no significant between-group difference (p = 0.209). ConclusionThe functional outcomes and mortality rates associated with SSBTKA are comparable to those associated with UTKA. The risk of complications and the need for revision, although higher with SSBTKA, the actual numbers are low enough to justify its use. Although the LOS in SSBTKA is longer than that in UTKA, it is likely to be shorter than the cumulative LOS for two UTKA procedures (i.e. a staged bilateral TKA). Thus, SSBTKA appears to be a safe and effective choice for appropriately selected patients.

Incidence of deep vein thrombosis before and after total knee arthroplasty without pharmacologic prophylaxis: a 128-row multidetector CT indirect venography study

BackgroundWe sought to document the incidences of deep vein thrombosis (DVT) before and after total knee arthroplasty (TKA). In addition, we aimed to explor whether routine preoperative DVT evaluation was useful to establish DVT treatment strategies after TKA. Finally, we wanted to evaluate whether the incidences of DVT differed between patients undergoing unilateral and staged bilateral TKA within the same hospitalization period.MethodsThe retrospective study included 153 consecutive patients (253 knees) with osteoarthritis who underwent primary TKA. After surgery, mechanical compression devices (only) were used for DVT prophylaxis. DVT status before and after TKA was determined via 128-row, multidetector, computed tomography/indirect venography.ResultsOverall, the preoperative DVT incidence was 2.6% per patient and 1.6% per knee. All preoperative DVTs were distal in nature and asymptomatic. After TKA, newly developed thrombi were evident in various calf veins, without propagation of any pre-existing thrombi. Postoperatively, the overall incidences of DVT were 69.9% per patient and 58.5% per knee. The DVT incidences were 66% per patient and 69.8% per knee in the unilateral TKA group. In contrast, the incidences were 72% per patient and 55.5% per knee in the staged bilateral TKA group. There was one case of symptomatic distal (unilateral TKA; 0.65% per patient and 0.4% per knee) and proximal DVT (bilateral TKA; 0.65% per patient and 0.4% per knee), respectively.ConclusionsThe incidence of symptomatic DVT was low in Asian patients treated with mechanical compression devices alone, although substantial portion of patients had DVT after surgery. Routine preoperative DVT evaluation is probably not necessary; preoperative DVT was rare and of limited clinical relevance. Furthermore, staged bilateral TKA during a single period of hospitalization does not increase the incidence of DVT.

Perioperative comparison of blood loss and complications between simultaneous bilateral and unilateral total knee arthroplasty for knee osteoarthritis

ObjectiveThis study aimed to compare the blood loss and complications between simultaneous bilateral total knee arthroplasty (SBTKA) and unilateral total knee arthroplasty (UTKA). MethodsThis study included 54 SBTKAs and 70 UTKAs performed between 2013 and 2014. Groups were compared with respect to blood loss, hemoglobin, hematocrit, D-dimer, blood transfusion, and complications. ResultsHemoglobin between the groups was not significantly different (P>0.05). In the SBTKA group, the hematocrit on the 3rd postoperative day was lower (P<0.05), and the D-dimer on the 1st postoperative day was higher (P<0.05) than in the UTKA group. The total drain output of the UTKA group was not significantly different from any unilateral side of the SBTKA group (P<0.05). The mean autologous red blood cell (RBC) transfusion requirements were not significantly different between the two groups. However, the mean allogeneic RBC transfusion requirement was higher in the SBTKA group than in the UTKA group (P<0.001). The total drainage of the SBTKA group was significantly more than the UTKA group, but the total drain output of the UTKA group was not significantly different from any unilateral side of the SBTKA group (P>0.05). Also, the mean allogeneic RBC transfusion requirement was higher in the SBTKA group than in the UTKA group (P<0.001). ConclusionThis study demonstrates that the rate of complication between SBTKA and UTKA is similar. The total drainage and transfusion of SBTKA are not twice that of UTKA, and after treatment, hemoglobin could be increased to a similar level. Thus, SBTKA is an effective and safe option.

Patient–machine interactions of intravenous patient-controlled analgesia in bilateral versus unilateral total knee arthroplasty: A retrospective study

BackgroundContinuous passive motion after a major knee surgery optimizes functional prognosis, but causes severe pain. In this study, we assessed the effect of intravenous patient-controlled analgesia (IVPCA) on postoperative pain management in unilateral and bilateral total knee arthroplasty (TKA). MethodsData were collected retrospectively from a single medical center from March 2003 to October 2007. All patients who had undergone TKA were given general anesthesia, and the type of surgery that each patient received was planned according to individual needs. A total of 223 patients qualified for this study, with 174 patients in the unilateral TKA group. Data on patient demography, pain scores, and side effect scores were collected. Total dose consumption, demand, delivery doses, demand-to-delivery ratio, and infusion rate were collected from PCA machines and analyzed. ResultsThe patient pain score and patient satisfaction showed no significant difference between the unilateral and bilateral TKA groups. The incidence of sedation (p < 0.001), nausea (p = 0.013), and vomiting (p = 0.044) during the postoperative 24–48-hour period was higher in the bilateral TKA group. Compared with the patients in the unilateral group, those in the bilateral group showed significantly greater dose consumption during the postoperative 6–12-, 12–18-, and 18–24-hour periods. They also showed more demand for medication during the postoperative 12–18- and 18–24-hour periods and received more bolus doses during the postoperative 12–18-, 18–24-, and 30–36-hour periods. In addition, there was also a significantly higher demand-to-delivery ratio for patients in the bilateral group during the postoperative 6–12-, 12–18-hour periods. ConclusionIn this study, we successfully demonstrated that our IVPCA protocol can provide adequate analgesia for patients after both bilateral and unilateral TKA. However, sedation, nausea, and vomiting occurred more frequently during the postoperative 24–48-hour period in patients who underwent bilateral than unilateral TKA. This may due of the increased number of bolus doses administered to the patients in the bilateral TKA group during the postoperative 12–18, 18–24, and 30–36-hour periods. Therefore, the initial infusion rates for patients undergoing bilateral TKA could be set at a lower threshold in order to reduce the incidence of these side effects.

Comparison of early postoperative functional activity levels of patients undergoing unilateral and bilateral total knee arthroplasty

We compared early postoperative functional activities of patients undergoing unilateral and bilateral total knee arthroplasty (TKA). A total of 241 patients underwent bilateral (n=130; 12 men, 118 women; mean age 67.5+/-7.6 years) or unilateral (n=111; 7 men, 104 women; mean age 66.3+/-9.0 years) primary TKA for gonarthrosis. All the patients had indications for bilateral TKA and received the same rehabilitation program postoperatively. Functional activities and walking speed of the patients were assessed with the Iowa Level of Assistance Scale and Ambulation Velocity Scale, respectively, before surgery and on the second and sixth postoperative days and during discharge. In addition, knee range of motion and HSS (Hospital for Special Surgery) knee scores were measured. There were no significant differences between the two groups preoperatively (p>0.05). Compared to baseline, functional activity levels during discharge showed significant improvement in both groups (p<0.05), whereas improvement in walking speed was significant only in the unilateral TKA group (p<0.05). Comparison of postoperative functional activity levels favored unilateral over bilateral TKA in all instances (p<0.05). The two groups did not differ significantly with respect to postoperative walking speed, HSS knee scores, range of motion of the knee, and mean hospital stay (p>0.05). Complications included knee hematoma (n=2) and deep vein thrombosis (n=1) in the unilateral TKA group, and knee hematoma (n=1) in the bilateral TKA group. Postoperative physiotherapy programs should consider decreases in functional activities of patients undergoing bilateral TKA.

The clinical comparison of simultaneous bilateral total knee arthroplasty in treatment of osteoarthritis

Objective To evaluate the risk and efficacy of simultaneous bilateral total knee arthroplasty(TKA) in treatment of osteoarthritis when compared with sequential bilateral TKA and unilateral TKA. Methods A retrospective analysis was performed on 162 patients who underwent TKA from 2003 to 2006. The analyses were adjusted for demographics, preexisting medical conditions, and osteoar-thritis diagnosis. Results Patients undergoing simultaneous bilateral TKA had significantly lower amounts of blood loss, shorter surgical time, shorter hospitalization time, less hospital charges and lower rates of perioperative complications compared with patients undergoing sequential bilateral TKA. No significant difference was found with regard to postoperative complications between the simultaneous bilateral and the unilateral TKA groups. Patient's knee range of motion and the postoperative Hospital for Special Surgery scores(HSS) were similar for the three groups. Conclusion When there are adequate indications for bilateral TKA, simultaneous bilateral TKA is beneficial to patients compared with sequential bilateral or unilateral TKA.

Lower-limb force production in individuals after unilateral total knee arthroplasty

Rossi MD, Hasson S. Lower-limb force production in individuals after unilateral total knee arthroplasty. Arch Phys Med Rehabil 2004;85:1279–84. Objective To determine and compare lower-limb force production during a single-leg horizontal press in involved and uninvolved limbs in people with unilateral total knee arthroplasty (TKA) and the limb of age- and gender-matched subjects. Design Quasi-experimental, posttest only control group design. Setting Subjects living in the community and were tested at a university facility. Participants Nine people with unilateral TKA and 9 subjects without TKA volunteered. The mean postsurgery time for the TKA group was 15.89±6.62 months. Interventions Not applicable. Main outcome measure Force production in kilograms during a single-leg press. Results Lower-limb force production differed significantly between involved and uninvolved limbs ( P=.007) for the unilateral TKA group. Lower-limb force production of the involved limb in persons with unilateral TKA was significantly lower than the limb of the age- and gender-matched controls ( P=.0001). Conclusions Lower-limb force production on the involved side was significantly lower than the uninvolved side. When compared with an age-matched control group, subjects with unilateral TKA produced less force during a single-leg horizontal press.

Sequential bilateral total knee arthroplasty under 1 anesthetic in patients ≥75 years old: Complications and functional outcomes

The objectives of this study were to determine the perioperative surgical and medical risks associated with sequential bilateral total knee arthroplasty (TKA) in patients ≥75 years old and to assess their functional status and overall level of satisfaction at follow-up. Study participants were 82 consecutive patients ≥75 years old who underwent a sequential bilateral TKA and 82 matched patients who underwent a unilateral TKA. There were 46 postoperative complications in the bilateral TKA group compared with 27 in the unilateral TKA group (P =.003). Postoperative cardiovascular complications were significantly greater in the sequential bilateral TKA group and were associated significantly with preoperative cardiovascular comorbidity. The mean Modified Hospital for Special Surgery knee score was rated as good (mean, 63.5 out of 80), and 95% of patients rated their knees as excellent or good at follow-up. Sequential bilateral TKA in patients ≥75 years old results in high patient satisfaction and good functional status at follow-up; however, there is an increased risk of cardiovascular complications during the postoperative period in bilateral sequential TKA patients when compared with a matched cohort of unilateral TKA patients.

Simultaneous Bilateral Versus Unilateral Total Knee Arthroplasty

One hundred consecutive, primary simultaneous bilateral total knee arthroplasties were prospectively compared with 100 consecutive, primary unilateral total knee arthroplasties in reference to relative risk, complications, cost, and need for rehabilitation. All procedures were performed using identical preoperative, intraoperative, and postoperative protocols. Postoperative confusion was approximately four times greater in the simultaneous bilateral total knee arthroplasties group (29% versus 7%), which was thought to represent an increased incidence of fat embolism. Cardiopulmonary complications were approximately three times greater after simultaneous bilateral total knee arthroplasties (14% versus 5%), and most commonly involved arrhythmias. The increased stress on the cardiopulmonary system with simultaneous bilateral total knee arthroplasties may make this procedure contraindicated in certain patients with preexisting disease. There was an approximately 17 times greater need for banked blood in the simultaneous bilateral total knee arthroplasties group (17% versus 1%), which is alarming given the persistent concerns of transfusion related disease transmission. Although the length of hospitalization was similar (6.4 days simultaneous bilateral total knee arthroplasties versus 6 days unilateral total knee arthroplasty), 89% of the patients in the simultaneous bilateral total knee arthroplasties group required a rehabilitation stay versus 45% of the patients in the unilateral total knee arthroplasty group. Total hospital charges averaged $53,168 for simultaneous bilateral total knee arthroplasties versus $32,598 for unilateral total knee arthroplasty. Total rehabilitation charges were similar. The relative cost savings implicit by doing simultaneous bilateral total knee arthroplasties seem to be at least partially offset by the approximately two times greater need for rehabilitation in this group. The true safety, efficacy, relative risk, and total cost analysis of simultaneous bilateral total knee arthroplasties demands further critical evaluation.

Complications After Concomitant Bilateral Total Knee Arthroplasty in Elderly Patients

To determine the risks associated with performance of bilateral total knee arthroplasty (TKA) in elderly patients. Ninety-eight patients with osteoarthritis who were 80 years of age or older and underwent concomitant cemented bilateral TKA were matched (on the basis of gender, surgeon, year of surgical treatment, age, and diagnosis) with 98 patients who underwent cemented unilateral TKA to compare the number and types of complications in these two groups. The groups did not differ in the number and type or severity of premorbid medical conditions, anesthetic risk, and type of anesthesia. One hundred nineteen postoperative complications occurred in 63 patients in the bilateral TKA group; in contrast, 72 complications occurred in 49 patients in the unilateral TKA group. The difference between the two groups in the total number of complications was significant. Specifically, significant differences between the two groups were noted in the occurrence of cardiovascular and neurologic complications. On paired analysis, congestive heart failure and acute delirium were found to be significantly more frequent in the bilateral TKA group than in the unilateral TKA group. We noted a trend toward an increased mortality rate in the bilateral group (four patients) versus the unilateral group (no deaths). Patients 80 years of age or older who undergo concomitant bilateral TKA are at increased risk for cardiovascular and neurologic complications during the postoperative period in comparison with matched patients who undergo unilateral TKA.