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J Knee Surg 2021; 34(09): 941-951
DOI: 10.1055/s-0039-1700979
Original Article

Simultaneous Bilateral Total Knee Arthroplasty Becomes Safer after Institution of Optimal Perioperative Management: A Longitudinal Cohort Study

Shih-Hao Chen
1   Department of Orthopaedic Surgery, Buddhist Tzu-Chi Hospital at Taichung, Taiwan
2   Department of Orthopaedics, Tzu-Chi University, Hualien, Taiwan
,
Jen-Yuh Chen
3   Postal Hospital, Taipei, Taiwan
4   Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
5   Department of Orthopedics, Taipei Medical University Hospital, Taipei, Taiwan
,
Tze-Hong Wong 
6   Department of Orthopedics, National Taiwan University Hospital, Hsin Chu Branch, HsinChu, Taiwan
,
Frederick Buechel Jr.
4   Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
7   Department of Orthopaedic Surgery, Lenox Hill Hospital, New York
8   Robotic Joint Center, New York
,
Meng-Huang Wu 
3   Postal Hospital, Taipei, Taiwan
4   Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
5   Department of Orthopedics, Taipei Medical University Hospital, Taipei, Taiwan
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Abstract

Simultaneous bilateral total knee arthroplasty (SBTKA) increases the rates of procedure-related complications and mortality compared with unilateral TKA. There are no well-defined guidelines for selecting patients to avoid mortality and proposing an upgrade treatment to decrease complication rates. This study aimed to evaluate whether optimal perioperative management could improve the safety of SBTKA. From 2005 to 2017, 1,166 cases of SBTKA were identified from 14,209 TKA procedures. We retrospectively examined the SBTKA patients' demographics, comorbidity profiles, procedure-related complications, and perioperative management during two time periods. Optimal perioperative workup for managing SBTKA significantly decreased the incidences of major complication from 6.2 to 2.4% (p = 0.001) and minor complications from 28.9 to 21.5% (p = 0.004) during period I and period II, respectively. The efficiency of less tourniquet use along with intraarticular tranexamic acid injection was demonstrated by the decreases of hemoglobin (Hb) change in the first 2 days after surgery (p = 0.005) and blood transfusion requirement (p = 0.035) during the SBTKA. Furthermore, the less tourniquet use group had less thigh pain (visual analog scale decreased from 6.0 to 4.2, p = 0.003), shorter duration of hospital stay (decreased from 7.8 to 7.1, p < 0.001), and lower coagulation time (decrease from 3.5 to 2.9, p < 0.001) than the routine tourniquet use group. Patient's screening must be performed carefully for cardiopulmonary compromise in patients aged >80 years and with an American Society of Anesthesiologists score of 3. Additionally, hospitalists should consider developing methods for the eligibility, testing, and perioperative monitoring of patients who undergo SBTKA with the aim of avoiding complications and improving outcomes.

Keywords

simultaneous bilateral total knee arthroplasty - patient selection - perioperative management - complication - tourniquet use


Publication History

Received: 09 April 2019

Accepted: 27 November 2019

Article published online:
17 January 2020

© 2020. Thieme. All rights reserved.

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