Low complication rates seen with sequential, bilateral uni knee replacements

Issue: November 2012

MANCHESTER — Researchers from the United Kingdom found low complication rates for patients who underwent single-stage sequential, bilateral unicompartmental knee replacements, according to results of a recently presented study.

Perspective from Roger H. Emerson, MD

“Single-stage sequential, bilateral unicompartmental knee replacements can be performed safely with no major complications and significant benefits to all concerned,” senior author David Houlihan-Burne, FRCS (Orth), told Orthopedics Today . “These benefits include a single hospital admission and anesthetic for the patient, a shorter total in-patient stay and enhanced rehabilitation when compared with having to mobilize one arthritic knee. This procedure achieves an overall shorter recovery period, with the achievement of a significant increase in function whilst also reducing overall costs for the hospital.”

In the study, which was presented at the British Orthopaedic Association Congress 2012, Houlihan-Burne and colleagues wanted to prove it was “safe, more convenient and cost-effective to perform surgery to both knees at one sitting, rather than having two separate admissions,” and that complication rates and readmissions would not increase with the single-stage procedure providing this procedure is to be performed in the setting of a rapid recover program.

They included 38 patients who underwent bilateral single-stage sequential (BSSS) unicompartmental total knee replacements (UKR) between 2006 and 2010. Patients had a mean follow-up of 20 months and mean age of 64 years. The researchers measured time to mobilization, average length of stay, pre- and postoperative Oxford Knee Scores (OKS) and total tourniquet time.

Mean total tourniquet time was 83 minutes. The average time to mobilization was 18 hours, and patients had an average length of stay of 3.5 days. The mean complication rate was 3.9%, with two patients who needed excision of superficial suture granulomas. One patient needed fixation of a tibial plateau fracture due to a fall, and no patients had thromboembolic events or deep infections.

David Houlihan-Burne

“No complications [were] related to the fact it was a single stage bilateral, but three complications […] may have happened even if unilateral surgery was performed,” Houlihan-Burne said.

Houlihan-Burne said future research will compare the functional results of these patients to those with both knees operated on at separate times.

“A single hospital admission and single period of recovery provided a quicker return to full function and work, preventing readmission for the second side 3 months after the first,” Houlihan-Burne said. – by Renee Blisard Buddle

Reference:

Akhtar K. #74. Presented at: The British Orthopaedic Association Congress; Sept. 11-14, 2012; Manchester.

For more information:

David Houlihan-Burne, FRCS (Orth), can be reached at Bishops Wood Hospital, Rickmansworth Rd, Northwood, Middx HA6 2JW United Kingdom; email: dhbsurgery@googlemail.com.

Disclosure: Houlihan-Burne has received fees from Biomet and Corin for lecturing and teaching purposes.

Perspective

Roger H. Emerson, MD

I like this study because it provides more data to support the increased use of partial knee replacements, because this procedure can restore knee comfort, alignment and function with reduced use of hospital resources and less risk to the patient. Bilateral partial knee replacement at one sitting is attractive because the patient is back to activities more quickly than staged replacements, but without the documented risks seen with bilateral simultaneous total knee replacement. I have found high patient acceptance for bilateral partial knee replacements.

Roger H. Emerson, MD

Director, Joint Institute at Texas Health

Presbyterian Hospital Plano Texas Center for Joint Replacement

Plano, Texas

Disclosures: Emerson is a consultant to Biomet and participates in the Oxford Partial Knee FDA-required instructional courses.