Bilateral TKA carries increased complication risk vs unilateral TKA
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Patients who had a bilateral total knee arthroplasty had an increased risk for complications compared with patients who had a unilateral TKA, suggesting bilateral TKA may not be safe even for healthy patients.
Robert M. Molloy, MD, said at the American Association of Hip and Knee Surgeons Annual Meeting that there could be some benefits to bilateral TKA, such as decreased overall length of stay, decreased overall anesthesia time and decreased cost compared with unilateral TKA; “however, there remains some controversy over whether these benefits outweigh the increasing complications, morbidity and mortality.”
Molloy and colleagues used data from the American College of Surgeons’ National Surgical Quality Improvement Program to match 8,291 patients who received a bilateral TKA in a 1:1 ratio by morbidity probability with a control cohort of patients who received a unilateral TKA. The American College of Surgeons developed the morbidity probability index “to provide a quantitative measure of the probability of morbidity for the patient using a logistic regression analysis,” Molloy said. Researchers wrote in the abstract that the index is calculated using demographics, comorbidities and laboratory values. Using morbidity probability, researchers categorized patients in quartiles and compared cohorts using binary logistic regression analysis to determine if any population of patients could safely undergo bilateral TKA.
Patients who received bilateral TKA had a higher risk for all complications, including major complications, compared with patients who had unilateral TKA. The first quartile, which comprised the healthiest patients, had a threefold increase for all complications and more than a twofold increase for major complications. The second and third quartiles had more than a fourfold increase for all complications. For major complications, the second quartile had more than a twofold increase and the third quartile had an almost threefold increase. The fourth quartile, which comprised the least healthy patients, had more than a threefold increase for all complications and a 57% increase for major complications. There were no significant differences in mortality between groups, regardless of health status, researchers wrote in the abstract.
“The conclusions of this study can and should be used when counseling patients regarding choices regarding whether to undergo bilateral [TKA] or unilateral [TKA],” Molloy said. “It should be presented to the patients that the risk of complication is higher in the bilateral [TKA] group and this should be used in the shared decision-making when making these choices.”
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C. Lowry Barnes, MD
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Molloy RM, et al. Paper 30. Presented at: American Association of Hip and Knee Surgeons Annual Meeting; Nov. 5-8, 2020; Dallas (hybrid meeting).
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