nach oben

Clinical Orthopaedics and Related Research®

Erschienen in:

01.11.2008 | Symposium: Papers Presented at the Annual Meetings of the Knee Society

In-hospital Complications and Mortality of Unilateral, Bilateral, and Revision TKA: Based on an estimate of 4,159,661 Discharges

verfasst von: Stavros G. Memtsoudis, MD, PhD, Alejandro González Della Valle, MD, Melanie C. Besculides, DrPH, MPH, Licia Gaber, BA, Thomas P. Sculco, MD

Erschienen in: Clinical Orthopaedics and Related Research® | Ausgabe 11/2008

Einloggen, um Zugang zu erhalten

Abstract

Patients undergoing bilateral total knee arthroplasty (BTKA) may have higher complication rates and mortality than those undergoing a unilateral procedure (UTKA). To evaluate this hypothesis, we analyzed nationally representative data collected for the National Hospital Discharge Survey on discharges after BTKA, UTKA, and revision TKA (RTKA) between 1990 and 2004. The demographics, comorbidities, in-hospital stay, complications, and mortality of each procedure were compared. An estimate of 4,159,661 discharges (153,259 BTKAs; 3,672,247 UTKAs; 334,155 RTKAs) were included. Patients undergoing BTKA were younger (1.5 years) and had a lower prevalence of comorbidities for hypertension (versus UTKA), diabetes, pulmonary disease, and coronary artery disease (versus UTKA and RTKA). The length of hospitalization was 5.8 days for BTKA, 5.3 for UTKA, and 5.4 for RTKA. Despite similar length of hospitalization, the prevalence of procedure-related complications was higher for BTKA (12.2%) compared with UTKA (8.2%) and RTKA (8.7%). In-hospital mortality was highest for patients undergoing BTKA (BTKA, 0.5%; UTKA, 0.3%; RTKA, 0.3%). Patients undergoing BTKA had a 1.6 times higher rate of procedure-related complications and mortality compared with those undergoing UTKA. Outcomes for patients undergoing RTKA for most variables were similar to those for UTKA. BTKA, advanced age, and male gender were independent risk factors for complications and mortality after TKA.

Level of Evidence: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Nur mit Berechtigung zugänglich

Adili A, Bhandari M, Petruccelli D, De Beer J. Sequential bilateral total knee arthroplasty under 1 anesthetic in patients > or = 75 years old: complications and functional outcomes. J Arthroplasty. 2001;16:271–278.PubMedCrossRef

Alemparte J, Johnson GV, Worland RL, Jessup DE, Keenan J. Results of simultaneous bilateral total knee replacement: a study of 1208 knees in 604 patients. J South Orthop Assoc. 2002;11:153–156.PubMed

Amin AK, Clayton RA, Patton JT, Gaston M, Cook RE, Brenkel IJ. Total knee replacement in morbidly obese patients. Results of a prospective, matched study. J Bone Joint Surg Br. 2006;88:1321–1326.PubMedCrossRef

Barrett J, Baron JA, Losina E, Wright J, Mahomed NN, Katz JN. Bilateral total knee replacement: staging and pulmonary embolism. J Bone Joint Surg Am. 2006;88:2146–2151.PubMedCrossRef

Besser MI. Bilateral Attenborough total knee replacement as a single procedure. Arch Orthop Trauma Surg. 1983;101:271–272.PubMedCrossRef

Bhattacharyya T, Iorio R, Healy WL. Rate of and risk factors for acute inpatient mortality after orthopaedic surgery. J Bone Joint Surg Am. 2002;84:562–572.PubMed

Bottner F, Pavone V, Johnson T, Heitkemper S, Sculco TP. Blood management after bilateral total knee arthroplasty. Clin Orthop Relat Res. 2003;410:254–261.PubMedCrossRef

Bozic KJ, Durbhakula S, Berry DJ, Naessens JM, Rappaport K, Cisternas M, Saleh KJ, Rubash HE. Differences in patient and procedure characteristics and hospital resource use in primary and revision total joint arthroplasty: a multicenter study. J Arthroplasty. 2005;20:17–25.PubMedCrossRef

Brotherton SL, Roberson JR, de Andrade JR, Fleming LL. Staged versus simultaneous bilateral total knee replacement. J Arthroplasty. 1986;1:221–228.PubMedCrossRef

10.

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;85:1981–1986.PubMed

11.

Dennis DA. Debate: bilateral simultaneous total knee arthroplasty. Clin Orthop Relat Res. 2004;428:82–83.PubMedCrossRef

12.

Dennison C, Pokras R. Design, operation of the National Hospital Discharge Survey: 1988 redesign. In: Vital and Health Statistics. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics; 2000;39:1–42.

13.

Diduch DR, Insall JN, Scott WN, Scuderi GR, Font-Rodriguez D. Total knee replacement in young, active patients. Long-term follow-up and functional outcome. J Bone Joint Surg Am. 1997;79:575–582.PubMed

14.

Font-Rodriguez DE, Scuderi GR, Insall JN. Survivorship of cemented total knee arthroplasty. Clin Orthop Relat Res. 1997;345:79–86.PubMedCrossRef

15.

Foran JR, Mont MA, Etienne G, Jones LC, Hungerford DS. The outcome of total knee arthroplasty in obese patients. J Bone Joint Surg Am. 2004;86:1609–1615.PubMed

16.

Foran JR, Mont MA, Rajadhyaksha AD, Jones LC, Etienne G, Hungerford DS. Total knee arthroplasty in obese patients: a comparison with a matched control group. J Arthroplasty. 2004;19:817–824.PubMedCrossRef

17.

Forster MC, Bauze AJ, Bailie AG, Falworth MS, Oakeshott RD. A retrospective comparative study of bilateral total knee replacement staged at a one-week interval. J Bone Joint Surg Br. 2006;88:1006–1010.PubMed

18.

Gandhi R, Petruccelli D, Devereaux PJ, Adili A, Hubmann M, de Beer J. Incidence and timing of myocardial infarction after total joint arthroplasty. J Arthroplasty. 2006;21:874–877.PubMedCrossRef

19.

Gill GS, Mills D, Joshi AB. Mortality following primary total knee arthroplasty. J Bone Joint Surg Am. 2003;85:432–435.PubMed

20.

Gillespie GN, Porteous AJ. Obesity and knee arthroplasty. Knee. 2007;14:81–86.PubMedCrossRef

21.

Griffin FM, Scuderi GR, Insall JN, Colizza W. Total knee arthroplasty in patients who were obese with 10 years followup. Clin Orthop Relat Res. 1998;356:28–33.PubMedCrossRef

22.

Hanssen AD, Pagnano MW. Revision of failed patellar components. Instr Course Lect. 2004;53:201–206.PubMed

23.

Hawker GA, Wright JG, Coyte PC, Williams JI, Harvey B, Glazier R, Badley EM. Differences between men and women in the rate of use of hip and knee arthroplasty. N Engl J Med. 2000;342:1016–1022.PubMedCrossRef

24.

Healy WL, Iorio R, Ko J, Appleby D, Lemos DW. Impact of cost reduction programs on short-term patient outcome and hospital cost of total knee arthroplasty. J Bone Joint Surg Am. 2002;84:348–353.PubMed

25.

Healy WL, Iorio R, Lemos MJ. Athletic activity after joint replacement. Am J Sports Med. 2001;29:377–388.PubMed

26.

Hersekli MA, Akpinar S, Ozalay M, Ozkoc G, Uysal M, Cesur N, Tandogan RN. A comparison between single- and two-staged bilateral total knee arthroplasty operations in terms of the amount of blood loss and transfusion, perioperative complications, hospital stay, and cost-effectiveness. Acta Orthop Traumatol Turc. 2004;38:241–246.PubMed

27.

Horne G, Devane P, Adams K. Complications and outcomes of single-stage bilateral total knee arthroplasty. ANZ J Surg. 2005;75:734–738.PubMedCrossRef

28.

Huotari K, Lyytikainen O, Seitsalo S. Patient outcomes after simultaneous bilateral total hip and knee joint replacements. J Hosp Infect. 2007;65:219–225.PubMedCrossRef

29.

Hutchinson JR, Parish EN, Cross MJ. A comparison of bilateral uncemented total knee arthroplasty: simultaneous or staged? J Bone Joint Surg Br. 2006;88:40–43.PubMedCrossRef

30.

Iezzoni LI, Foley SM, Daley J, Hughes J, Fisher ES, Heeren T. Comorbidities, complications, and coding bias. Does the number of diagnosis codes matter in predicting in-hospital mortality? JAMA. 1992;267:2197–2203.PubMedCrossRef

31.

Jain NB, Higgins LD, Ozumba D, Guller U, Cronin M, Pietrobon R, Katz JN. Trends in epidemiology of knee arthroplasty in the United States, 1990–2000. Arthritis Rheum. 2005;52:3928–3933.PubMedCrossRef

32.

Katz JN, Barrett J, Mahomed NN, Baron JA, Wright RJ, Losina E. Association between hospital and surgeon procedure volume and the outcomes of total knee replacement. J Bone Joint Surg Am. 2004;86:1909–1916.PubMedCrossRef

33.

Kim YH. Incidence of fat embolism syndrome after cemented or cementless bilateral simultaneous and unilateral total knee arthroplasty. J Arthroplasty. 2001;16:730–739.PubMedCrossRef

34.

Kim YH, Oh SW, Kim JS. Prevalence of fat embolism following bilateral simultaneous and unilateral total hip arthroplasty performed with or without cement: a prospective, randomized clinical study. J Bone Joint Surg Am. 2002;84:1372–1379.PubMed

35.

Kolettis GT, Wixson RL, Peruzzi WT, Blake MJ, Wardell S, Stulberg SD. Safety of 1-stage bilateral total knee arthroplasty. Clin Orthop Relat Res. 1994;309:102–109.PubMed

36.

Kovacik MW, Singri P, Khanna S, Gradisar IA. Medical and financial aspects of same-day bilateral total knee arthroplasties. Biomed Sci Instrum. 1997;33:429–434.PubMed

37.

Kurtz S, Mowat F, Ong K, Chan N, Lau E, Halpern M. Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002. J Bone Joint Surg Am. 2005;87:1487–1497.PubMedCrossRef

38.

Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89:780–785.PubMedCrossRef

39.

Lachiewicz PF, Ranawat CS. Fat embolism syndrome following bilateral total knee replacement with total condylar prosthesis: report of two cases. Clin Orthop Relat Res. 1981;160:106–108.PubMed

40.

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;345:106–112.PubMedCrossRef

41.

Leitch KK, Dalgorf D, Borkhoff CM, Kreder HJ. Bilateral total knee arthroplasty–staged or simultaneous? Ontario’s orthopedic surgeons reply. Can J Surg. 2005;48:273–276.PubMed

42.

Leonard L, Williamson DM, Ivory JP, Jennison C. An evaluation of the safety and efficacy of simultaneous bilateral total knee arthroplasty. J Arthroplasty. 2003;18:972–978.PubMedCrossRef

43.

Liu TK, Chen SH. Simultaneous bilateral total knee arthroplasty in a single procedure. Int Orthop. 1998;22:390–393.PubMedCrossRef

44.

Lombardi AV, Mallory TH, Fada RA, Hartman JF, Capps SG, Kefauver CA, Dodds K, Adams JB. Simultaneous bilateral total knee arthroplasties: who decides? Clin Orthop Relat Res. 2001;392:319–329.PubMedCrossRef

45.

Macario A, Schilling P, Rubio R, Goodman S. Economics of one-stage versus two-stage bilateral total knee arthroplasties. Clin Orthop Relat Res. 2003;414:149–156.PubMedCrossRef

46.

Mahomed NN, Barrett J, Katz JN, Baron JA, Wright J, Losina E. Epidemiology of total knee replacement in the United States Medicare population. J Bone Joint Surg Am. 2005;87:1222–1228.PubMedCrossRef

47.

Mangaleshkar SR, Prasad PS, Chugh S, Thomas AP. Staged bilateral total knee replacement–a safer approach in older patients. Knee. 2001;8:207–211.PubMedCrossRef

48.

Mantilla CB, Horlocker TT, Schroeder DR, Berry DJ, Brown DL. Frequency of myocardial infarction, pulmonary embolism, deep venous thrombosis, and death following primary hip or knee arthroplasty. Anesthesiology. 2002;96:1140–1146.PubMedCrossRef

49.

March LM, Cross M, Tribe KL, Lapsley HM, Courtenay BG, Cross MJ, Brooks PM, Cass C, Coolican M, Neil M, Pinczewski L, Quain S, Robertson F, Ruff S, Walter W, Zicat B. Two knees or not two knees? Patient costs and outcomes following bilateral and unilateral total knee joint replacement surgery for OA. Osteoarthritis Cartilage. 2004;12:400–408.PubMedCrossRef

50.

Meding JB, Reddleman K, Keating ME, Klay A, Ritter MA, Faris PM, Berend ME. Total knee replacement in patients with diabetes mellitus. Clin Orthop Relat Res. 2003;416:208–216.PubMedCrossRef

51.

Morrey BF, Adams RA, Ilstrup DM, Bryan RS. Complications and mortality associated with bilateral or unilateral total knee arthroplasty. J Bone Joint Surg Am. 1987;69:484–488.PubMed

52.

Nunley RM, Lachiewicz PF. Mortality after total hip and knee arthroplasty in a medium-volume university practice. J Arthroplasty. 2003;18:278–285.PubMedCrossRef

53.

Oakes DA, Hanssen AD. Bilateral total knee replacement using the same anesthetic is not justified by assessment of the risks. Clin Orthop Relat Res. 2004;428:87–91.PubMedCrossRef

54.

Parvizi J, Mui A, Purtill JJ, Sharkey PF, Hozack WJ, Rothman RH. Total joint arthroplasty: when do fatal or near-fatal complications occur? J Bone Joint Surg Am. 2007;89:27–32.PubMedCrossRef

55.

Parvizi J, Sullivan TA, Trousdale RT, Lewallen DG. Thirty-day mortality after total knee arthroplasty. J Bone Joint Surg Am. 2001;83:1157–1161.PubMed

56.

Pavone V, Johnson T, Saulog PS, Sculco TP, Bottner F. Perioperative morbidity in bilateral one-stage total knee replacements. Clin Orthop Relat Res. 2004;421:155–161.PubMedCrossRef

57.

Powell RS, Pulido P, Tuason MS, Colwell CW Jr, Ezzet KA. Bilateral vs unilateral total knee arthroplasty: a patient-based comparison of pain levels and recovery of ambulatory skills. J Arthroplasty. 2006;21:642–649.PubMedCrossRef

58.

Primary total hip and total knee arthroplasty projections to 2030. Bulletin of the American Academy of Orthopaedic Surgeons. Rosemont, IL: American Academy of Orthopaedic Surgeons; 1998.

59.

Radmer S, Andresen R, Sparmann M. Simultaneous bilateral total knee arthroplasty in patients with rheumatoid arthritis. Z Orthop Ihre Grenzgeb. 2006;144:472–476.PubMedCrossRef

60.

Restrepo C, Parvizi J, Dietrich T, Einhorn TA. Safety of simultaneous bilateral total knee arthroplasty. A meta-analysis. J Bone Joint Surg Am. 2007;89:1220–1226.PubMedCrossRef

61.

Reuben JD, Meyers SJ, Cox DD, Elliott M, Watson M, Shim SD. Cost comparison between bilateral simultaneous, staged, and unilateral total joint arthroplasty. J Arthroplasty. 1998;13:172–179.PubMedCrossRef

62.

Ritter M, Mamlin LA, Melfi CA, Katz BP, Freund DA, Arthur DS. Outcome implications for the timing of bilateral total knee arthroplasties. Clin Orthop Relat Res. 1997;345:99–105.PubMedCrossRef

63.

Ritter MA, Harty LD. Debate: simultaneous bilateral knee replacements: the outcomes justify its use. Clin Orthop Relat Res. 2004;428:84–86.PubMedCrossRef

64.

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;85:1532–1537.PubMed

65.

Schafer M, Elke R, Young JR, Gancs P, Kindler CH. Safety of one-stage bilateral hip and knee arthroplasties under regional anaesthesia and routine anaesthetic monitoring. J Bone Joint Surg Br. 2005;87:1134–1139.PubMedCrossRef

66.

Selected articles using National Hospital Discharge Survey or National Survey of Ambulatory Surgery data. Centers for Disease Control and Prevention. 2007. Available at: http://www.cdc.gov/nchs/data/hdasd/NHDS2007articleupdate.pdf. Accessed October 19, 2007.

67.

Shah K, Smith J, Jones B, Hullin M. Bilateral total knee replacement under a single anaesthetic, using a cementless implant is not unsafe. Knee Surg Sports Traumatol Arthrosc. 2007;15:269–275.PubMedCrossRef

68.

Sierra RJ, Cooney WP 4th, Pagnano MW, Trousdale RT, Rand JA. Reoperations after 3200 revision TKAs: rates, etiology, and lessons learned. Clin Orthop Relat Res. 2004;425:200–206.PubMedCrossRef

69.

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. 2005;87:508–513.PubMedCrossRef

70.

SooHoo NF, Lieberman JR, Ko CY, Zingmond DS. Factors predicting complication rates following total knee replacement. J Bone Joint Surg Am. 2006;88:480–485.PubMedCrossRef

71.

SooHoo NF, Zingmond DS, Lieberman JR, Ko CY. Primary total knee arthroplasty in California 1991 to 2001: does hospital volume affect outcomes? J Arthroplasty. 2006;21:199–205.PubMedCrossRef

72.

Soudry M, Binazzi R, Insall JN, Nordstrom TJ, Pellicci PM, Goulet JA. Successive bilateral total knee replacement. J Bone Joint Surg Am. 1985;67:573–576.PubMed

73.

Stanley D, Stockley I, Getty CJ. Simultaneous or staged bilateral total knee replacements in rheumatoid arthritis. A prospective study. J Bone Joint Surg Br. 1990;72:772–774.PubMed

74.

Stubbs G, Pryke SE, Tewari S, Rogers J, Crowe B, Bridgfoot L, Smith N. Safety and cost benefits of bilateral total knee replacement in an acute hospital. ANZ J Surg. 2005;75:739–746.PubMedCrossRef

75.

Sturmer T, Gunther KP, Brenner H. Obesity, overweight and patterns of osteoarthritis: the Ulm Osteoarthritis Study. J Clin Epidemiol. 2000;53:307–313.PubMedCrossRef

76.

Vessely M, Harmsen WS, Schleck C, Melton LJ, Kurland R, Berry D. James A. Rand Award Paper: a population based study of trends in use of total hip and knee arthroplasty. J Arthroplasty. 2007;22:303.CrossRef

77.

Vessely MB, Whaley AL, Harmsen WS, Schleck CD, Berry DJ. The Chitranjan Ranawat Award: long-term survivorship and failure modes of 1000 cemented condylar total knee arthroplasties. Clin Orthop Relat Res. 2006;452:28–34.PubMedCrossRef

78.

Walmsley P, Murray A, Brenkel IJ. The practice of bilateral, simultaneous total knee replacement in Scotland over the last decade. Data from the Scottish Arthroplasty Project. Knee. 2006;13:102–105.PubMedCrossRef

79.

Worland RL, Jessup DE, Clelland C. Simultaneous bilateral total knee replacement versus unilateral replacement. Am J Orthop. 1996;25:292–295.PubMed

Titel: In-hospital Complications and Mortality of Unilateral, Bilateral, and Revision TKA: Based on an estimate of 4,159,661 Discharges
verfasst von: Stavros G. Memtsoudis, MD, PhD
Alejandro González Della Valle, MD
Melanie C. Besculides, DrPH, MPH
Licia Gaber, BA
Thomas P. Sculco, MD
Publikationsdatum: 01.11.2008
Verlag: Springer-Verlag
Erschienen in: Clinical Orthopaedics and Related Research® / Ausgabe 11/2008
Print ISSN: 0009-921X
Elektronische ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-008-0402-5

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen.
» Jetzt entdecken

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Knie-TEP: Kein Vorteil durch antibiotikahaltigen Knochenzement

29.05.2024 Periprothetische Infektionen Nachrichten

Zur Zementierung einer Knie-TEP wird in Deutschland zu über 98% Knochenzement verwendet, der mit einem Antibiotikum beladen ist. Ob er wirklich besser ist als Zement ohne Antibiotikum, kann laut Registerdaten bezweifelt werden.

Häusliche Gewalt in der orthopädischen Notaufnahme oft nicht erkannt

28.05.2024 Häusliche Gewalt Nachrichten

In der Notaufnahme wird die Chance, Opfer von häuslicher Gewalt zu identifizieren, von Orthopäden und Orthopädinnen offenbar zu wenig genutzt. Darauf deuten die Ergebnisse einer Fragebogenstudie an der Sahlgrenska-Universität in Schweden hin.

Fehlerkultur in der Medizin – Offenheit zählt!

28.05.2024 Fehlerkultur Podcast

Darüber reden und aus Fehlern lernen, sollte das Motto in der Medizin lauten. Und zwar nicht nur im Sinne der Patientensicherheit. Eine negative Fehlerkultur kann auch die Behandelnden ernsthaft krank machen, warnt Prof. Dr. Reinhard Strametz. Ein Plädoyer und ein Leitfaden für den offenen Umgang mit kritischen Ereignissen in Medizin und Pflege.

Mehr Frauen im OP – weniger postoperative Komplikationen

21.05.2024 Allgemeine Chirurgie Nachrichten

Ein Frauenanteil von mindestens einem Drittel im ärztlichen Op.-Team war in einer großen retrospektiven Studie aus Kanada mit einer signifikanten Reduktion der postoperativen Morbidität assoziiert.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 11/2008

Highly Crosslinked Polyethylene is Safe for Use in Total Knee Arthroplasty

Does Patellar Eversion in Total Knee Arthroplasty Cause Patella Baja?

Posterior Cruciate-retaining Total Knee Arthroplasty for Valgus Osteoarthritis

Men versus Women

Stemmed Implants Improve Stability in Augmented Constrained Condylar Knees

Rotational Position of Femoral and Tibial Components in TKA Using the Femoral Transepicondylar Axis