Mayo Clinic ProceedingsComplications After Concomitant Bilateral Total Knee Arthroplasty in Elderly Patients
Section snippets
PATIENTS AND METHODS
All patients 80 years of age or older who had not had a prior surgical procedure performed on either knee and who underwent primary concomitant bilateral cemented TKA for osteoarthritis between 1982 and 1991 were identified. Any patient who had undergone any other joint replacement within 3 months of the bilateral TKA was excluded from this study. Ninety-eight patients undergoing concomitant bilateral TKA who fulfilled the criteria were identified and matched to 98 patients undergoing
RESULTS
A total of 136 intraoperative, immediate postoperative, and posthospitalization (within 1 year after the procedure) complications occurred in the bilateral group (in 69 patients); 81 complications occurred in the unilateral group (in 54 patients) (P<0.002). The ASA level was not predictive of the total number of complications in either group.
Intraoperative hypotension that necessitated use of stimulants or pressors was documented in 14 patients in the bilateral group and 8 patients in the
DISCUSSION
Previous reports on the subject have failed to document a difference in medical and surgical complication rates between unilateral and bilateral TKA. In fact, the reported frequency of specific cardiovascular, pulmonary, gastrointestinal, genitourinary, and neurologic complications is low, as is the rate of surgical complications.1, 2, 3, 4, 6, 7, 8, 9, 10, 11, 12, 15, 20, 21, 22, 23 These published data have resulted in the expansion of indications for and performance of concomitant bilateral
CONCLUSION
The purpose of this article was not to answer the question whether performance of concomitant bilateral TKA is safer or less safe than use of a staged procedure. Rather, the purpose of this review was to determine the risks associated with bilateral TKA in elderly patients. Elderly patients undergoing any orthopedic procedure may be at higher risk for complications than their younger counterparts. Careful preoperative evaluation and postoperative monitoring of hemodynamic variables, hemoglobin,
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For accompanying editorial, see page 895
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