Skip to main content
SpringerLink
Log in

Simultaneous vs staged bilateral total knee arthroplasty: a propensity-matched case–control study from nine fast-track centres

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

    We’re sorry, something doesn't seem to be working properly.

    Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.

Abstract

Introduction

Limited data exist on patient safety after simultaneous vs staged bilateral total knee arthroplasty (TKA) in matched groups. Hence, the aim of this study was to compare length of stay (LOS), in-hospital complications, 30-day readmissions and mortality after simultaneous and staged bilateral TKA in matched patients.

Patients and methods

A retrospective case–control study of prospectively collected data in nine centres from February 2010 to November 2015. Propensity scores (PS) were used to match simultaneous and staged (1–6 months between stages) bilateral TKA patients with prospectively collected patient characteristics from the Lundbeck Foundation Centre for Fast-track THA and TKA Database. 30-day follow-up was acquired from the Danish Patient Registry and patient records.

Results

A total of 344 (47.1%) simultaneous and 386 (52.9%) staged bilateral TKA procedures were performed. PS matching was possible in 232 simultaneous and 232 staged bilateral TKA patients. LOS was median 4 days (IQR 3–5) after simultaneous and cumulated 4 days (IQR 4–6) after staged procedures. The in-hospital complication rate was 15.5% after simultaneous vs 7.3% (p = 0.004) after staged procedures. Two cases (0.9%) of venous thromboembolic events were found in each group. Eight patients (3.4%) were re-operated after simultaneous vs one patient (0.4%) after staged bilateral TKA (p = 0.037). The 30-day readmission rate was 8.6% after simultaneous vs 5.6% after staged procedures (p = 0.281). No patients died in either group.

Conclusions

We found no significant differences in 30-day readmission rates and mortality between simultaneous and staged bilateral TKA, but the in-hospital complication rate and re-operation rate was higher after the simultaneous procedure calling for further matched investigations in larger cohorts.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Metcalfe AJ, Andersson ML, Goodfellow R, Thorstensson CA (2012) Is knee osteoarthritis a symmetrical disease? Analysis of a 12 year prospective cohort study. BMC Musculoskelet Disord 13:153

    Article  PubMed  PubMed Central  Google Scholar 

  2. Bolognesi MP, Watters TS, Attarian DE, Wellman SS, Setoguchi S (2013) Simultaneous vs staged bilateral total knee arthroplasty among Medicare beneficiaries, 2000–2009. J Arthroplast 28:87–91

    Article  Google Scholar 

  3. Hooper GJ, Hooper NM, Rothwell AG, Hobbs T (2009) Bilateral total joint arthroplasty: the early results from the New Zealand National Joint Registry. J Arthroplast 24:1174–1177

    Article  Google Scholar 

  4. Lindberg-Larsen M, Jorgensen CC, Husted H, Kehlet H (2015) Early morbidity after simultaneous and staged bilateral total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 23:831–837

    Article  PubMed  Google Scholar 

  5. Poultsides LA, Rasouli MR, Maltenfort MG, Parvizi J, Memtsoudis SG, Sculco TP (2014) Trends in same-day bilateral total knee arthroplasty. JArthroplasty 29:1713–1716

    Article  Google Scholar 

  6. Husted H (2012) Fast-track hip and knee arthroplasty. Clinical and organizational aspects. Acta OrthopSuppl 83:1–39

    Article  Google Scholar 

  7. Kehlet H (2013) Fast-track hip and knee arthroplasty. Lancet 381:1600–1602

    Article  Google Scholar 

  8. Fransen BL, Hoozemans MJM, Argelo KDS, Keijser LCM, Burger BJ.(2018) Fast-track total knee arthroplasty improved clinical and functional outcome in the first 7 days after surgery: a randomized controlled pilot study with 5-year follow-up. Arch Orthop Trauma Surg 138(9):1305–1316

    Article  PubMed  PubMed Central  Google Scholar 

  9. Gromov K, Troelsen A, Stahl OK, Orsnes T, Husted H (2016) Morbidity and mortality after bilateral simultaneous total knee arthroplasty in a fast-track setting. Acta Orthop 87:286–290

    Article  PubMed  PubMed Central  Google Scholar 

  10. Hart A, Antoniou J, Brin YS, Huk OL, Zukor DJ, Bergeron SG (2016) Simultaneous bilateral versus unilateral total knee arthroplasty: a comparison of 30-day readmission rates and major complications. J Arthroplast 31:31–35

    Article  Google Scholar 

  11. Husted H, Troelsen A, Otte KS, Kristensen BB, Holm G, Kehlet H (2011) Fast-track surgery for bilateral total knee replacement. J Bone Joint Surg Br 93:351–356

    Article  CAS  PubMed  Google Scholar 

  12. Sheth DS, Cafri G, Paxton EW, Namba RS (2016) Bilateral simultaneous vs staged total knee arthroplasty: a comparison of complications and mortality. J Arthroplast 31:212–216

    Article  Google Scholar 

  13. Meehan JP, Danielsen B, Tancredi DJ, Kim S, Jamali AA, White RH (2011) A population-based comparison of the incidence of adverse outcomes after simultaneous-bilateral and staged-bilateral total knee arthroplasty. J Bone Joint Surg Am 93:2203–2213

    Article  PubMed  Google Scholar 

  14. Peskun C, Mayne I, Malempati H, Kosashvili Y, Gross A, Backstein D (2012) Cardiovascular disease predicts complications following bilateral total knee arthroplasty under a single anesthetic. Knee 19:580–584

    Article  PubMed  Google Scholar 

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

    Article  Google Scholar 

  16. Stefansdottir A, Lidgren L, Robertsson O (2008) Higher early mortality with simultaneous rather than staged bilateral TKAs: results from the Swedish Knee Arthroplasty Register. Clin Orthop Relat Res 466:3066–3070

    Article  PubMed  PubMed Central  Google Scholar 

  17. Sobh AH, Siljander MP, Mells AJ, Koueiter DM, Moore DD, Karadsheh MS (2018) Cost analysis, complications, and discharge disposition associated with simultaneous vs staged bilateral total knee arthroplasty. J Arthroplast 33:320–323

    Article  Google Scholar 

  18. Bini SA, Khatod M, Inacio MC, Paxton EW (2014) Same-day versus staged bilateral total knee arthroplasty poses no increase in complications in 6672 primary procedures. J Arthroplast 29:694–697

    Article  Google Scholar 

  19. Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement (2018) http://www.fthk.dk/. Accessed 30 Oct 2018

  20. Jorgensen CC, Jacobsen MK, Soeballe K, Hansen TB, Husted H, Kjaersgaard-Andersen P, Hansen LT, Laursen MB, Kehlet H (2013) Thromboprophylaxis only during hospitalisation in fast-track hip and knee arthroplasty, a prospective cohort study. BMJ Open 3(12):e003965

    Article  PubMed  PubMed Central  Google Scholar 

  21. Jorgensen CC, Kehlet H (2013) Role of patient characteristics for fast-track hip and knee arthroplasty. Br J Anaesth 110:972–980

    Article  CAS  PubMed  Google Scholar 

  22. Jorgensen CC, Pitter FT, Kehlet H (2017) Safety aspects of preoperative high-dose glucocorticoid in primary total knee replacement. Br J Anaesth 119(2):267

    Article  CAS  PubMed  Google Scholar 

  23. Lynge E, Sandegaard JL, Rebolj M (2011) The Danish national patient register. Scand J Public Health 39:30–33

    Article  Google Scholar 

  24. Andersen TF, Madsen M, Jorgensen J, Mellemkjoer L, Olsen JH (1999) The Danish National Hospital Register. A valuable source of data for modern health sciences. DanMedBull 46:263–268

    CAS  Google Scholar 

  25. Austin PC (2011) An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivar Behav Res 46:399–424

    Article  Google Scholar 

Download references

Acknowledgements

We thank the staff at the nine centres for the assistance with fulfilling of preoperative questionnaires from the patients. The study was sponsored by a grant from the Lundbeck Foundation (grant number: R25-A2702). The Lundbeck Foundation Centre for Fast-Track Hip and Knee Replacement Collaborative Group consists of: Frank Madsen, Department of Orthopedics, Aarhus University Hospital, Aarhus University, Aarhus, Denmark; Torben B. Hansen, Department of Orthopedics, Regional Hospital Holstebro, Aarhus University, Aarhus, Denmark; Søren Solgaard, Orthopedic Department, Copenhagen University Hospital Gentofte, Copenhagen University, Copenhagen, Denmark; Mogens B. Laursen, Orthopedic Division, Aalborg Hospital, Aalborg University, Aalborg, Denmark; Lars T. Hansen, Orthopedic Department, Sydvestjysk Hospital Esbjerg/Grindsted, Esbjerg, Denmark; Per Kjærsgaard-Andersen, Department of Orthopedics, Vejle Hospital, University of Southern Denmark, Odense, Denmark; Lars P.Jorn, Orthopedics Department, Viborg Regional Hospital, Viborg, Denmark and Jens Bagger, Department of Orthopaedic Surgery, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark.

Author information

Authors and Affiliations

  1. The Lundbeck Foundation Centre for Fast-track Hip and Knee Arthroplasty, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark

    M. Lindberg-Larsen, H. Husted, H. Kehlet & C. C. Jørgensen

  2. Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, J. B. Winsløvsvej 4, 5000, Odense C, Denmark

    M. Lindberg-Larsen

  3. Section of Surgical Pathophysiology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark

    F. T. Pitter, H. Kehlet & C. C. Jørgensen

  4. Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, 2650, Hvidovre, Denmark

    H. Husted

Authors
  1. M. Lindberg-Larsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. F. T. Pitter
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. H. Husted
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. H. Kehlet
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. C. C. Jørgensen
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

The Lundbeck Foundation Centre for Fast-Track Hip and Knee Replacement Collaborative Group

  • Frank Madsen
  • , Torben B. Hansen
  • , Søren Solgaard
  • , Mogens B. Laursen
  • , Lars T. Hansen
  • , Per Kjærsgaard-Andersen
  • , Lars P. Jorn
  •  & Jens Bagger

Corresponding author

Correspondence to M. Lindberg-Larsen.

Ethics declarations

Conflict of interest

The study was sponsored by a grant from the Lundbeck Foundation (Grant number: R25-A2702). No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. No conflicts of interest were declared from the authors of this study.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The members of the Lundbeck Foundation Centre for Fast-Track Hip and Knee Replacement Collaborative Group are given in the acknowledgement section.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lindberg-Larsen, M., Pitter, F.T., Husted, H. et al. Simultaneous vs staged bilateral total knee arthroplasty: a propensity-matched case–control study from nine fast-track centres. Arch Orthop Trauma Surg 139, 709–716 (2019). https://doi.org/10.1007/s00402-019-03157-z

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-019-03157-z

Keywords

Search

Navigation