Study identifies patients at increased risk of morbidity, mortality after bilateral TKA

Stavros Memtsoudis

A study by researchers at the Hospital for Special Surgery has found patients who have a history of significant medical issues — especially congestive heart failure or pulmonary hypertension — are at increased risk for major complications following total knee arthroplasty.

The study appears online ahead of print in Anesthesia & Analgesia.

“What we sought to do for the first time with this study was to provide evidence-based risk stratification for who should be considered at high risk for morbidity and mortality when undergoing bilateral knee replacement surgery,” lead author Stavros Memtsoudis, MD, PhD, stated in a press release. “This is an elective procedure, so in the end, the primary concern should be for patient safety.”

Complication rates and risk factors

Memtsoudis and his group collected and analyzed data from the Nationwide Inpatient Survey from 1998 to 2007, including in their study all reported cases of elective bilateral total knee arthroplasty (TKA). Their analysis included patient demographics and comorbidities, as well as frequencies of mortality and major complications. Multivariate analysis was used to examine any independent risk factors for major morbidity and mortality.

The study found 42,003 database entries representing 206,573 elective bilateral TKAs. The researchers reported an incidence rate of 9.5% for major in-hospital complications and mortality, noting advanced age, male gender, congestive heart failure and pulmonary hypertension were the most significant risk factors for increased odds of adverse outcome.

Patients undergoing bilateral TKA were 5.5 times more likely to have adverse outcomes if they had congestive heart failure — and 4 times more likely to have adverse outcomes if they had pulmonary hypertension. Patients were also twice as likely to display complications if they were older than 75 years. Men were 50% more likely than women to experience complications.

Adopting an approach

Memtsoudis noted in the release that patients with congestive heart failure and pulmonary hypertension are more likely to experience complications in part because of the bone particles and marrow that enter the bloodstream during orthopedic surgery.

“Clinicians need to adopt an approach when doing this surgery that reconciles the benefits of bilateral knee replacement surgery and concerns for safety,” Memtsoudis stated.

Reference:

Memtsoudis SG, Ma Y, Chiu Y, et al. Bilateral total knee arthroplasty: Risk factors for major morbidity and mortality. Anesth Analg. 2011. doi: 10.1213/?ANE.0b013e3182282953

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