Original Articles
Sequential bilateral total knee arthroplasty under 1 anesthetic in patients ≥75 years old: Complications and functional outcomes*,**

https://doi.org/10.1054/arth.2001.21495Get rights and content

Abstract

The objectives of this study were to determine the perioperative surgical and medical risks associated with sequential bilateral total knee arthroplasty (TKA) in patients ≥75 years old and to assess their functional status and overall level of satisfaction at follow-up. Study participants were 82 consecutive patients ≥75 years old who underwent a sequential bilateral TKA and 82 matched patients who underwent a unilateral TKA. There were 46 postoperative complications in the bilateral TKA group compared with 27 in the unilateral TKA group (P =.003). Postoperative cardiovascular complications were significantly greater in the sequential bilateral TKA group and were associated significantly with preoperative cardiovascular comorbidity. The mean Modified Hospital for Special Surgery knee score was rated as good (mean, 63.5 out of 80), and 95% of patients rated their knees as excellent or good at follow-up. Sequential bilateral TKA in patients ≥75 years old results in high patient satisfaction and good functional status at follow-up; however, there is an increased risk of cardiovascular complications during the postoperative period in bilateral sequential TKA patients when compared with a matched cohort of unilateral TKA patients.

Section snippets

Materials and methods

All patients ≥75 years old with osteoarthritis of the knee who underwent a bilateral TKA between 1991 and 1998 under 1 anesthetic were identified from a prospectively tabulated arthroplasty database. Strict inclusion criteria included clinically significant osteoarthritic changes in both knees, age ≥75 years, and failure of conservative treatment for osteoarthritis of the knee. Strict exclusion criteria included history of previous knee infection, trauma requiring surgery, or previous

Results

There were 62 women and 20 men in the sequential bilateral TKA group and 56 women and 26 men in the unilateral TKA group. There was no statistically significant difference between the 2 groups with respect to mean age, average weight, height, and body mass index (Table 1).

. Baseline Comparison of Elderly Patients Who Underwent Total Knee Arthroplasty

Patient FactorsSequential Bilateral TKAUnilateral TKAP Value
No. patients8282
Mean age (y) (range)78.6 (75-92)77.9 (75-84)NS
No. women6256NS
No. men2026NS

Discussion

The prevalence of arthritis increases linearly with age, from 6.3% in the 16- to 24-year-old age group to 51.2% for the ≥75-year-old group [1]. The ratio of osteoarthritis to rheumatoid arthritis is estimated at 22:1, and osteoarthritis is the most frequently reported reason for long-term disability in the population [1]. Zicat et al [20] reported that patients who reach 80 years of age have a life expectancy of 8 years if female and 6 years if male. With an increasing average age of the North

Conclusion

Sequential bilateral TKA in patients ≥75 years old results in high overall patient satisfaction, good functional status, and restoration of functional independence at follow-up. There is a significantly greater incidence of postoperative cardiovascular complications in the sequential bilateral TKA group when compared with the unilateral TKA group, which is associated significantly with a preexisting cardiovascular condition. Although previous studies did not show conclusively that a 2-stage

References (32)

  • EM Badley

    The effect of osteoarthritis on disability and health care use in Canada

    J Rheumatol

    (1995)
  • BF Morrey et al.

    Complications and mortality associated with bilateral and unilateral total knee arthroplasty

    J Bone Joint Surg Am

    (1987)
  • E Funke et al.

    Bilateral total knee arthroplasty (TKA): simultaneous or staged?

    J Bone Joint Surg Br

    (1995)
  • WT Hardaker et al.

    Simultaneous and staged bilateral total knee arthroplasty

    J Bone Joint Surg Am

    (1978)
  • JP Ivory et al.

    Bilateral knee replacements: simultaneous or staged?

    J R Coll Surg Edinb

    (1993)
  • JJ Jankiewicz et al.

    One-staged versus 2-staged bilateral total knee arthroplasty

    Clin Orthop

    (1994)

    • Cited by (0)

    *

    No benefits or funds were received in support of this study.

    **

    Reprint requests: Anthony Adili, MD, PEng, % Danielle Petruccelli, The Hamilton Arthroplasty Group, Hamilton Health Sciences Corporation, Henderson General Campus, Hamilton, Ontario, Canada, L8V 1C3. E-mail: [email protected]

    View full text
    Copyright © 2001 Churchill Livingstone. Published by Elsevier Inc. All rights reserved.