Abstrakt
Background: When patients present with end-stage
bilateral knee arthritis, the decision facing both the
patient and the surgeon is whether to replace both
knees in one sitting (simultaneous bilateral total knee
replacement) SMBTKR or to undertake one knee
replacement and after an interval of time and as a
separate episode, replace the other knee (staged
bilateral total knee replacement) STBTKR. There is
concern regarding the safety of undertaking
SMBTKR. The study is a review to determine the
risk benefit profile of SMBTKR compared to a
staged procedure (STBTKR).
Methods: A literature search of MEDLINE and
EMBASE from inception to April 2019 was carried
out. 26 studies qualified for inclusion in the review. A
systematic review was undertaken using narrative
synthesis. Methodological quality was assessed with
the use of risk of bias tool developed by Warby et al
(2014).
Results: The studies were of moderate quality with
low to moderate risk of bias. There is evidence that
the risk of complications may be increased when
patients with chronic cardiac and pulmonary illness
undergo SMBTKR. There may also be increased risk
of confusion and mortality in the frail elderly patient
(>75yrs). There is increased blood loss with this
approach. Benefits include superior rehabilitation
and functional outcome and lower cost associated
with SMBTKR. Patients not suitable for SMBTKR
are best treated as STBTKR.
Reference
Trojani C, Bugnas B, Blay M, Carles M, Boileau
P. Bilateral total knee arthroplasty in a one-stage
surgical procedure. Orthopaedics &
Traumatology: Surgery & Research. 2012;
(8):771-776.
Ritter MA, Harty LD, Davis KE, Meding JB,
Berend M. Simultaneous bilateral, staged
bilateral, and unilateral total knee arthroplasty:
a survival analysis. J Bone Joint Surg Am. 2003;
(8):1532-1537.
Luscombe JC,Theivendran K, Abudu A, Carter
SR.The relative safety of one-stage bilateral total
knee arthroplasty. Int Orthop. 2009 Feb; 33(1):
–104.
Sheth DS, Cafri G, Paxton EW, Namba RS.
Bilateral Simultaneous vs Staged Total Knee
Arthroplasty: A Comparison of Complications
and Mortality. J Arthroplasty. 2016 Sep; 31(9
Suppl):212-216
Memtsoudis SG, Besculides MC, Reid S, GaberBaylis LK, González Della Valle A,Trends in
Bilateral Total Knee Arthroplasties: 153,259
Discharges between 1990 and 2004. Clin Orthop
Relat Res. 2009 Jun; 467(6): 1568–1576.
Bagsby D, Pierson JL. Functional Outcomes of
Simultaneous Bilateral Versus Unilateral Total
Knee Arthroplasty. Orthopedics. 2015;38(1):
e43-e47.
Tong Ma, Yi-Hui Tu, Hua-Ming Xue, Tao
Wen, Min-Wei Cai. Clinical Outcomes and Risks
of Single-stage Bilateral Unicompartmental
Knee Arthroplasty via Oxford Phase III. Chin
Med J (Engl). 2015 Nov 5; 128(21): 2861–2865.
Jankiewicz JJ, Sculco TP, Ranawat CS, Behr C,
Tarrentino S. One-stage versus 2-stage bilateral
total knee arthroplasty. Clin Orthop Relat Res.
; (309):94-101.
Kovacik MW, Singri P, Khanna S, Gradisar IA.
Medical and financial aspects of same day
bilateral total knee arthroplasties. Biomedical
Sciences Instrumentation. 1997; 33:429-434.
Aaron Chih-Chang Lin, En Chao, Che-Ming
Yang, Hsyien-Chia Wen, Hsiao-Li Ma, TzuChuan Lu. Costs of staged versus simultaneous
bilateral total knee arthroplasty: a population-
Balogun M, Ayekoloye C, Oyewole G and Ogunlade O
based study of the Taiwanese National Health
Insurance Database.J Orthop Surg Res. 2014; 9:
Odum SM, Troyer JL, Kelly MP, Dedini
RD, Bozic KJ. A cost-utility analysis comparing
the cost-effectiveness of simultaneous and staged
bilateral total knee arthroplasty. J Bone Joint
Surg Am. 2013 Aug 21;95(16):1441-1449.
Sliva CD, Callaghan JJ, Goetz DD, Taylor SG.
Staggered Bilateral Total Knee Arthroplasty
Performed Four to Seven Days Apart During a
Single Hospitalization. J Bone Joint Surg Am.
; 87a(3):508-513.
Anyaehie UE, Eyichukwu GO, Nwadinigwe CU.
Total knee replacement in a resource constrained
environment: A preliminary report. Niger J Clin
Pract 2017;20:369-75.
Adebusoye LA, Ogunbode AM, Alonge
TO. Magnitude of knee osteoarthritis and
associated risk factors among adult patients
presenting in a family practice clinic in Nigeria.
J Med Trop. 2013;15(2):144-150
Liu TK, Chen SH. Simultaneous bilateral total
knee arthroplasty in a single procedure. Int
Orthop 1998;22(6):390–393
Liberati A, Altman DG, Tetzlaff J. The PRISMA
statement for reporting systematica reviews and
meta-analyses of studies that evaluate healthcare
interventions: explanation and elaboration. Br.
Med J, 21 (2009), pp. 339-341.
Warby S. Pizzari T, Ford J, Hahne A and Watson,
Exercise-based management versus surgery for
multidirectional instability of the glenohumeral
joint: a systematic review. Br J Sports Med 2015;
: 1-10.
Stundner O, Chiu Y-L, Sun X, Mazumdar M,
Fleischut P, Poultsides L, Gerner P, Fritsch G,
Memtsoudis SG. Comparative Perioperative
Outcomes Associated With Neuraxial Versus
General Anesthesia for Simultaneous Bilateral
Total Knee Arthroplasty. Regional Anesthesia &
Pain Medicine, November/December 2012.
Lane GJ, Hozack WJ, Shah S, Rothman RH,
Booth RE Jr, Eng K, Smith P. Simultaneous
bilateral versus unilateral total knee arthroplasty.
Outcomes analysis. Clin Orthop Relat Res. 1997
Dec; (345):106-112.
Turnbull ZA, Sastow D, Giambrone GP, Tedore
T. Anesthesia for the patient undergoing total
knee replacement: current status and future
prospects. Local Reg Anesth. 2017; 10: 1–7.
Haddad B, Khan W, Mehta V, Mbubaegbu
C, Qamar A. Bilateral Simultaneous Total Knee
Arthroplasty: A Patient-Matched Retrospective
Observational Study. Open Orthop J. 2015; 9:
–503.
Kang HI, Han CD, Jahng JS, Ko SO. Blood gas
and electrolyte changes after tourniquet
application in total knee replacement surgery.
Yonsei Med J 1992;33:153-158.
Canadian Institute for Health Information.
Outcomes for Simultaneous and Staged Bilateral
Total Knee Replacement Surgeries. Ottawa, ON:
CIHI; 2016.
Bullock DP, Sporer SM, Shirreffs TG Jr.
Comparison of simultaneous bilateral with
unilateral total knee arthroplasty in terms of
perioperative complications. J Bone Joint Surg
Am 2003;85-A (10):1981–1986.
Restrepo C, Parvizi J, Dietrich T, Einhorn T A.
Safety of simultaneous bilateral total knee
arthroplasty. A meta-analysis. J Bone Joint Surg
(Am) 2007; 89(6): 1220-6.
Gradillas EL, Volz RG. Bilateral total knee
replacement under one anesthetic. Clin Orthop
Relat Res 1979;140(140):153–158.
Bohm ER, Molodianovitsh K, Dragan A, Zhu
N, Webster G, Masri B, Schemitsch E, Dunbar
M. Outcomes of unilateral and bilateral total
knee arthroplasty in 238,373 patients. Acta
Orthop. 2016 Jul; 87(Suppl 1): 24–30.
Memtsoudis S G, González Della Valle A,
Besculides M C, Gaber L, Sculco T P. In-hospital
complications and mortality of unilateral,
bilateral, and revision TKA: based on an estimate
of 4,159,661 discharges. Clin Orthop Relat Res
; 466(11): 2617-27.
Memtsoudis SG, Mantilla CB, Parvizi J,
Stundner O, Mazumdar M. Have Bilateral Total
Knee Arthroplasties Become Safer? A
Population-Based Trend Analysis. Clin Orthop
Relat Res.2013; 471:17–25.
Poultsides LA Rasouli MR, Maltenfort
MG, Parvizi J, Memtsoudis SG, Sculco TP.
Trends in same-day bilateral total knee
arthroplasty. J Arthroplasty. 2014
Sep;29(9):1713-6.
Scaltriti S, Cencetti S, Rovesti S, Marchesi I,
Bargellini A, Borella P. Risk factors for
particulate and microbial contamination of air
in operating theatres.J Hosp Infect. 2007 Aug;
(4):320-6.
Al-Maiyah M, Bajwa A, Mackenney P, Port A,
Gregg PJ, Hill D, Finn P. Glove perforation and
contamination in primary total hip arthroplasty.
J Bone Joint Surg Br. 2005 Apr; 87(4):556-9.
Comparison of trilogy of cost, complications, and functional outcome 197
Johnson R, Jameson SS, Sanders RD, Sargant
NJ, Muller SD, Meek RMD, Reed MR.
Reducing surgical site infection in arthroplasty
of the lower limb: A multi-disciplinary approach.
Bone Joint Res. 2013 Mar; 2(3): 58–65.
So-Osman C,Nelissen RGHH,Koopman-van
Gemert AWMM, Kluyver E, Pöll RG, Onstenk
R, Van Hilten JA, Jansen-Werkhoven TM, van
den Hout WB, Brand R, Brand A.Patient Blood
Management in Elective Total Hip- and Kneereplacement Surgery (Part 1): A Randomized
Controlled Trial on Erythropoietin and Blood
Salvage as Transfusion Alternatives Using a
Restrictive Transfusion Policy in Erythropoietineligible Patients. Anesthesiology 04 2014,
Vol.120, 839-851.
Rajiv Gandhi, Heather MK Evans, Safiyyah R
Mahomed, Nizar N Mahomed. Tranexamic acid
and the reduction of blood loss in total knee and
hip arthroplasty: a meta-analysis. BMC Research
Notes. 2013; 6:184.
McGrath S, Yates P, Prosser G. Oral Tranexamic
Acid in Hip and Knee Arthroplasty: A
Prospective Cohort Study. Open Journal of
Orthopedics, 2014, 4, 215-220.
Lee QJ, Ching WY, Wong YC. Blood Sparing
Efficacy of Oral Tranexamic Acid in Primary
Total Knee Arthroplasty: A Randomized
Controlled Trial. Knee Surg Relat Res. 2017 Mar
;29(1):57-62. doi: 10.5792/ksrr.16.074.