One-stage Bilateral Total Joint Arthroplasty: A Prospective, Comparative Study of Total Hip and Total Knee Replacement

Link  http://www.orthosupersite.com/view.asp?rID=25675

By E. Louis Peak, MD; William J. Hozack, MD; Peter F. Sharkey, MD; Javad Parvizi, MD, FRCS; Richard H. Rothman, MD, PhD
ORTHOPEDICS 2008; 31:131

Abstract

This prospective study compared the incidence of minor and major complications in 50 patients (100 joints) undergoing bilateral total knee arthroplasty (TKA) with 50 patients (100 joints) undergoing bilateral total hip arthroplasty (THA). Gender, comorbidities, American Society of Anesthesiologists scores, and body mass indices were similar in both groups. There was no difference in preoperative hemoglobin, operative time, anesthetic management, postoperative surveillance, and hemoglobin at discharge. However, the need for allogenic blood transfusion, despite preoperative autologous blood donation and retransfusion, was high for both groups (34% for bilateral TKA and 20% for bilateral THA. Bilateral THA patients had lower rates of total major and minor complications than bilateral TKA patients. Although cementless bilateral THA and cemented bilateral TKA can be performed efficiently and with relative safety in a select group of patients, the high rate of minor complications and in particular the need for allogenic transfusion in both groups is concerning and should be discussed with patients before surgery.

The potential medical risk to patients of performing simultaneous bilateral total hip arthroplasty (THA) or total knee arthroplasty (THA) under one anesthetic continues to be debated in the orthopedic community. Some studies have raised concerns regarding the safety of the procedures,^1-4 while some advocate bilateral joint arthroplasty only in a select group of patients^5-12 and still others advocate bilateral joint arthroplasty for all patients.^13,14

The reported incidence of complications following bilateral joint arthroplasty varies greatly. In a study by Berger et al,¹ serious complications in one-stage hybrid bilateral THA were found to be 3 times higher than in staged procedures. Other studies have refuted the latter and have shown bilateral THA to be a safe procedure even in older patients.¹⁵ Other retrospective studies^16-19 evaluating uncemented one-stage bilateral THA exclusively have found the procedure to be well-tolerated with similar complications to unilateral or staged bilateral procedures. The conflicting recommendations from these studies and the potential concern regarding safety deter some surgeons from performing one-staged bilateral THA and to some extent bilateral TKA.^2-4,20

This study was designed specifically to elucidate the incidence and to define the nature and the circumstances surrounding minor and major complications occurring following one-stage bilateral THA and knee TKA. Furthermore, the study sought to compare the incidence of complications between the two procedures and to identify patients who may be at risk for such complications.