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Changing indications for bilateral TKA did not decrease complications

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Indicating younger patients for bilateral total knee arthroplasty (TKA) has not decreased complications over time as previously expected, according to a study by researchers at Hospital for Special Surgery published ahead of print in the journal Clinical Orthopaedics and Related Research.

Although absolute in-hospital mortality decreased by 10% every year and length of stay in hospitals decreased from approximately 5 days to 4 days, other complications remained the same or increased, according to Stavros Memtsoudis, MD, PhD, director of Critical Care Services at Hospital for Special Surgery.

 

Stavros Memtsoudis

“The take home message of this paper is that we are fighting an uphill battle because people are getting sicker, despite us attempting to limit risk by choosing younger people to do these procedures in,” Memtsoudis stated in a press release. “We have to start thinking of other interventions other than patient selection that we can implement in order to reduce these complications.”

While congestive heart failure rates decreased over time in bilateral TKA cases, Memtsoudis and colleagues saw a 3% increase in both pneumonia and non-myocardial infarctions in time, as well as a 6% increase in pulmonary emboli. They observed higher rates of neurological disease, renal failure, diabetes, chronic obstructive pulmonary disease, and liver disease even though the average age of patients decreased by 2.5 years.

“Although we are selecting younger people, we cannot ignore the fact that the population in general is getting sicker,” Memtsoudis stated. “Many of the complications that we studied did not decrease over time as you would expect with younger patients and better health care, and some of the complications even increased.”

Memtsoudis and colleagues studied 258,524 bilateral TKAs from the Nationwide Inpatient Survey. During the study period the rate of bilateral knee replacement increased 75%. Bilateral procedures represented 3.7% of all TKAs performed in 1999, but by 2008 those procedures represented 6% of all TKAs performed, according to the abstract.

Reference:

Memtsoudis SG, Mantilla CB, Parvizi J, et al. Have bilateral total knee arthroplasties become safer?: A population-based trend analysis. Clin Orthop Rel Res. 2012. Published online before print Sept. 24, 2012. doi: 10.1007/s11999-012-2608-9.