Abstract
Introduction
With the rising utilization of total joint arthroplasty, the role of simultaneous-bilateral surgery has expanding impact. The purpose of this study is to examine the risk of perioperative complications for this approach in total knee arthroplasty to inform shared decision making.
Methods
We used nation-wide linked discharge data from the Hospital Cost and Utilization Project from 2005–2014 comparing outcomes of simultaneous-bilateral and staged-bilateral total knee arthroplasties (TKAs). Hierarchical logistic regression analysis was used to compare mortality within 30 days, 90 days and 1 year, perioperative risks within 30–60 days, and infection and mechanical complications within 1 year.
Results
63,579 patients were analyzed including 27,301 simultaneous-bilateral and 36,278 staged-bilateral TKAs. Patients who underwent simultaneous surgery had a significantly higher adjusted odds ratio of death within 30 days (OR=3.31, 95% CI=2.15–5.08, p<0.001), myocardial infarction (OR=2.54, 95% CI=1.96–3.28, p<0.001), ischemic stroke (OR=2, 95% CI=1.39–2.87, p=0.002), cardiac complications (OR=1.3, 95% CI=1.12–1.5, p=0.007), digestive complications (OR=1.85, 95% CI=1.59–2.15, p<0.001), deep vein thrombosis (OR=1.31, 95% CI=1.18–1.45, p<0.001), and pulmonary embolism (OR=1.76, 95% CI=1.49–2.08, p<0.001) with a lower adjusted odds ratio of hematoma (OR=0.55, 95% CI=0.45–0.68, p<0.001), knee infection (OR=0.83, 95% CI=0.71–0.98, p=0.023), and major mechanical malfunction (OR=0.78, 95% CI=0.65–0.94, p=0.009). There was no difference in the adjusted OR for minor mechanical malfunction. The absolute risk difference for any complication between groups was 1% or less.
Conclusion
Despite higher odds of experiencing many complications for patients undergoing simultaneous-bilateral versus staged total knee arthroplasty, the absolute difference in perioperative risks between these groups is small. This study of a large population informs surgeons and patients regarding the safety of simultaneous surgery.
Level of Evidence: Therapeutic Level III
Keywords: knee arthroplasty; simultaneous; bilateral; staged; joint replacement
