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J Knee Surg 2023; 36(07): 702-709
DOI: 10.1055/s-0041-1741000
Original Article

The BTK Safety Score: A Novel Scoring System for Risk Stratifying Patients Undergoing Simultaneous Bilateral Total Knee Arthroplasty

Kevin Y. Wang 
1   Department of Orthopedic Surgery, The Johns Hopkins University, Baltimore, Maryland
,
Varun Puvanesarajah
1   Department of Orthopedic Surgery, The Johns Hopkins University, Baltimore, Maryland
,
Micheal Raad
1   Department of Orthopedic Surgery, The Johns Hopkins University, Baltimore, Maryland
,
Kawsu Barry
1   Department of Orthopedic Surgery, The Johns Hopkins University, Baltimore, Maryland
,
Umasuthan Srikumaran
1   Department of Orthopedic Surgery, The Johns Hopkins University, Baltimore, Maryland
,
Savyasachi C. Thakkar
1   Department of Orthopedic Surgery, The Johns Hopkins University, Baltimore, Maryland
› Author Affiliations
Funding None.
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Abstract

Selection of appropriate candidates for simultaneous bilateral total knee arthroplasty (si-BTKA) is crucial for minimizing postoperative complications. The aim of this study was to develop a scoring system for identifying patients who may be appropriate for si-BTKA. Patients who underwent si-BTKA were identified in the National Surgical Quality Improvement Program database. Patients who experienced a major 30-day complication were identified as high-risk patients for si-BTKA who potentially would have benefitted from staged bilateral total knee arthroplasty. Major complications included deep wound infection, pneumonia, renal insufficiency or failure, cerebrovascular accident, cardiac arrest, myocardial infarction, pulmonary embolism, sepsis, or death. The predictive model was trained using randomly split 70% of the dataset and validated on the remaining 30%. The scoring system was compared against the American Society of Anesthesiologists (ASA) score, the Charlson Comorbidity Index (CCI), and legacy risk-stratification measures, using area under the curve (AUC) statistic. Total 4,630 patients undergoing si-BTKA were included in our cohort. In our model, patients are assigned points based on the following risk factors: +1 for age ≥ 75, +2 for age ≥ 82, +1 for body mass index (BMI) ≥ 34, +2 for BMI ≥ 42, +1 for hypertension requiring medication, +1 for pulmonary disease (chronic obstructive pulmonary disease or dyspnea), and +3 for end-stage renal disease. The scoring system exhibited an AUC of 0.816, which was significantly higher than the AUC of ASA (0.545; p < 0.001) and CCI (0.599; p < 0.001). The BTK Safety Score developed and validated in our study can be used by surgeons and perioperative teams to risk stratify patients undergoing si-BTKA. Future work is needed to assess this scoring system's ability to predict long-term functional outcomes.

Keywords

total knee arthroplasty - risk stratification - bilateral knee arthroplasty - scoring system - joint arthroplasty - knee osteoarthritis

Ethical Approval

This study was deemed IRB exempt by our institutional review board.




Publication History

Received: 25 October 2020

Accepted: 16 November 2021

Article published online:
03 January 2022

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