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Comparison of the Effect and Complications of Sequential Bilateral Arthroplasty at Different Time Intervals and Simultaneous Bilateral Total Knee Arthroplasty: A Single-Centre Retrospective Cohort Study
Advances in Therapy ( IF 3.8 ) Pub Date : 2021-08-28 , DOI: 10.1007/s12325-021-01880-x
Shenqi Zhang 1 , Fengyan Wang 1 , Chengbin Wang 1 , Cunping Wang 2 , Yanan Xu 3 , Xingbo Long 4 , Xiaolin Ni 4 , Lei Shi 3 , Qingyun Xue 3 , Benlong Wang 1
Affiliation  

Introduction

To the authors' knowledge, there is no current consensus regarding the optimal interprocedural interval for patients who have undergone bilateral total knee arthroplasty (BTKA). The purpose of this study is to evaluate complication rates and functional outcome in patients who have undergone BTKA (simultaneous or sequential at different time intervals), and to determine an optimal time frame for the second knee.

Methods

Data from 315 patients who were able to tolerate simultaneous BTKA according to the anaesthesiologist’s preoperative assessment between 2016 and 2020 were analysed retrospectively. According to the operative time interval, they were divided into simultaneous, ≤ 1-month sequential, 1- to 3-month sequential, and ≥ 3-month sequential BTKA groups. The primary outcomes were revision and readmission rates during the follow-up period, and the secondary outcomes were hospital length of stay (LOS), transfusion and postoperative complications.

Results

There was no difference in the implant survival or readmission rate between the groups (p > 0.05). Multivariable linear regression showed that interprocedural interval and body mass index (BMI) affected LOS; the LOS of simultaneous BTKA was the shortest (p < 0.05). BMI was associated with an increased LOS of 0.25 days (95% CI 0.02–0.48, p = 0.03). A modified Poisson regression model showed that the odds of blood transfusion were reduced in sequential BTKAs of any interval (p < 0.05), and preoperative haemoglobin (Hb) was also a risk factor (RR 0.96, 95% CI 0.95–0.98, p < 0.001). The interprocedural interval was not a risk factor for postoperative cardiovascular and cerebrovascular complications.

Conclusion

For appropriate patients, simultaneous BTKA is beneficial. However, higher preoperative haemoglobin was required to mitigate the high blood transfusion rate associated with simultaneous surgeries. If suitable patients refuse simultaneous BTKA for other non-medical reasons, sequential BTKA with an interval greater than 1 month is recommended.



中文翻译:

不同时间间隔顺序双侧人工关节置换术与双侧全膝关节置换术的效果和并发症比较:单中心回顾性队列研究

介绍

据作者所知,目前对于接受双侧全膝关节置换术 (BTKA) 的患者的最佳手术间间隔没有达成共识。本研究的目的是评估接受 BTKA(在不同时间间隔同时或顺序)的患者的并发症发生率和功能结果,并确定第二膝的最佳时间范围。

方法

回顾性分析了 2016 年至 2020 年间根据麻醉师的术前评估能够耐受同步 BTKA 的 315 名患者的数据。根据手术时间间隔分为同时、≤1个月序贯、1~3个月序贯、≥3个月序贯BTKA组。主要结果是随访期间的翻修率和再入院率,次要结果是住院时间(LOS)、输血和术后并发症。

结果

两组之间的种植体存活率或再入院率没有差异(p  > 0.05)。多变量线性回归显示,手术间间隔和体重指数(BMI)影响 LOS;同时 BTKA 的 LOS 最短(p  < 0.05)。BMI 与 LOS 增加 0.25 天相关(95% CI 0.02–0.48,p  = 0.03)。改进的泊松回归模型显示,在任何时间间隔的连续 BTKA 中输血的几率降低 ( p  < 0.05),术前血红蛋白 (Hb) 也是一个危险因素(RR 0.96,95% CI 0.95–0.98,p  < 0.001)。手术间间隔不是术后心脑血管并发症的危险因素。

结论

对于合适的患者,同时使用 BTKA 是有益的。然而,需要更高的术前血红蛋白来减轻与同时手术相关的高输血率。如果合适的患者因其他非医学原因拒绝同时进行 BTKA,推荐间隔大于 1 个月的序贯 BTKA。

更新日期:2021-08-29
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