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J Knee Surg 2023; 36(04): 362-367
DOI: 10.1055/s-0041-1733884
Original Article

Perioperative Complications in Patients over 70 Years of Age following Simultaneous Bilateral Total Knee Arthroplasty

Landon Kozai
1   John A. Burns School of Medicine, Honolulu, Hawaii
,
Maya Matsumoto
1   John A. Burns School of Medicine, Honolulu, Hawaii
2   Straub Medical Center, Bone and Joint Center, Honolulu, Hawaii
,
Kristin Mathews
2   Straub Medical Center, Bone and Joint Center, Honolulu, Hawaii
,
Samantha Andrews 
2   Straub Medical Center, Bone and Joint Center, Honolulu, Hawaii
3   Department of Surgery, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
,
Cass Nakasone
2   Straub Medical Center, Bone and Joint Center, Honolulu, Hawaii
3   Department of Surgery, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
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Abstract

Single-stage bilateral total knee arthroplasty (ssBTKA) can be used for patients presenting with bilateral arthritis and may result in fewer systemic and wound complications compared with two, independent procedures. However, the safety of ssBTKA in the elderly remains controversial. Therefore, the purpose of this study was to compare early complications and transfusion rates following ssBTKA in patients ≤ 70 years old or > 70 years old. This retrospective chart review of 313 consecutive patients undergoing ssBTKA included 174 patients ≤ 70 years old and 139 patients > 70 years old. Perioperative variables and postoperative complications were compared with univariate analyses between age groups. Multivariate analyses were performed to determine risk factors for developing perioperative complications and transfusions. Compared with patients ≤ 70, patients > 70 had significantly lower body mass index (p < 0.001) and were more commonly female (p = 0.024). Although wound (p > 0.12) and systemic complications (p > 0.54) were similar, 23% of patients > 70 required transfusion compared with only 8% of patients ≤ 70 (p < 0.001). Patients with preoperative anemia (p < 0.001), age > 70 (p = 0.002), or diabetes mellitus (p = 0.007) were at 5.7, 3.3, and 2.9 times greater risk for requiring a transfusion, respectively. Patients > 70 undergoing ssBTKA have a similar complication profile to patients ≤ 70 years old, suggesting age should not be an absolute exclusion criterion for ssBTKA. However, the risk of transfusion was significantly higher in those > 70, despite lower tourniquet times. Treatment of preoperative anemia may decrease the risk of transfusion and could provide adequate safety for patients > 70 to undergo ssBTKA by an experienced surgeon.

Keywords

single-stage bilateral - elderly - complications - transfusion - anemia


Publication History

Received: 26 January 2021

Accepted: 21 June 2021

Article published online:
04 August 2021

© 2021. Thieme. All rights reserved.

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333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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