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Prolonged or rapid total knee arthroplasty surgery may be detrimental to patients
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Total knee arthroplasty procedures that take longer than 120 minutes to complete or are completed in less than 40 minutes are associated with greater rates of complications and revisions, according to a presenter.
Simon W. Young, MD, FRACS, and colleagues conducted a study to analyze the effect of surgical duration on functional outcomes and revision rates for a primary total knee arthroplasty (TKA).
“We found a clear association between a prolonged operative time greater than 120 minutes and higher revision rates in TKA surgery. This is perhaps understandable as longer procedures are more likely in complex cases, or if an intraoperative complication occurs. We also found for primary TKAs lasting less than 120 minutes, there was no evidence that further shortening operative time led to improved patient outcomes. In fact, we found a somewhat paradoxical trend toward an increased risk of revision in very rapid procedures less than 40 minutes,” Young told Orthopaedics Today Europe.
Longer duration affected outcomes
Using the New Zealand National Joint Registry, the investigators analyzed 58,009 primary TKAs performed in patients with knee osteoarthritis between 1999 and 2012. Investigators grouped the procedures by surgical duration into those that lasted less than 40 minutes, 40 minutes to 59 minutes, 60 minutes to 89 minutes, 120 minutes to 179 minutes, and procedures that lasted more than 180 minutes from start to end.
The mean duration of the surgeries studied was 89 minutes and the majority of them (76%) lasted between 60 minutes and 120 minutes. There was no statistically significant difference in revision rates for procedures lasting between 40 minutes and 120 minutes, according to the investigators, but those that lasted longer than 120 minutes showed significantly higher revision rates (P < .01).
In addition, procedures that lasted less than 40 minutes showed a trend toward more revisions, with 0.71 revisions per 100 component years compared with 0.48 revisions per 100 component years for procedures that lasted longer than 40 minutes; however, this difference was not statistically significant (P = .1), according to the findings. About 1.1% of procedures in the study were completed in less than 40 minutes.
Faster may not be better
Young said the mean Oxford Knee Score was 1 to 2 points lower at 6 months and at 5 years after surgery in patients whose operations lasted less than 40 minutes compared with patients whose operations lasted 60 to 89 minutes, but this was not a statistically significant difference.
The conclusion of the study was that prolonged operatives times are indeed more likely in more complex cases and they can have poorer outcomes and more revisions. However, the investigators noted that their study suggests that TKA can be performed too quickly to the detriment of a patient.
“We would suggest that surgeons looking to increase throughput do so with caution and ensure that surgical technique is not compromised in pursuit of a more rapid operation,” Young said. – by Robert Linnehan
- Reference:
- Young SW, et al. Does speed matter? Revision rates and functional outcomes in TKA in relation to duration of surgery. Presented at: Knee Society Specialty Day; March 28, 2015; Las Vegas.
- For more information:
- Simon W. Young, MD, FRACS, can be reached at University of Auckland, Department of Orthopaedic Surgery, North Shore Hospital; 124 Shakespeare Rd., Takapuna Private Bag 93-503, Auckland 0740, New Zealand; email: simonwyoung@gmail.com.
Disclosure: Young reports no relevant financial disclosures.