Restrepo Camilo, Parvizi Javad, Dietrich Thomas, Einhorn Thomas A
Department of Orthopedic Surgery, Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107, USA.
J Bone Joint Surg Am. 2007 Jun;89(6):1220-6. doi: 10.2106/JBJS.F.01353.
The safety of simultaneous bilateral total knee replacement remains controversial. Some studies have demonstrated a higher rate of serious complications, including death, following bilateral procedures, whereas others have suggested no increase in the complication rate. The objective of this meta-analysis was to compare the safety of simultaneous bilateral total knee replacement with that of staged bilateral and unilateral total knee replacements.
A computerized literature search was conducted to identify all citations, from 1966 to 2005, concerning bilateral total knee replacement. All of the English-language abstracts were obtained. A multistage assessment was then performed to identify articles fulfilling the inclusion criteria for the study. All randomized, prospective studies reporting the outcome of bilateral total knee replacement were included. The details of the reported data were extracted, and an extensive analysis of relevant variables was carried out.
One hundred and fifty published articles were identified, and eighteen that included a total of 27,807 patients (44,684 knees) were included in the meta-analysis. There were 10,930 unilateral total knee replacements, 16,419 simultaneous bilateral total knee replacements, and 458 staged bilateral total knee replacements with at least three months between the operative procedures. The prevalences of pulmonary embolism (odds ratio = 1.8), cardiac complications (odds ratio = 2.49), and mortality (odds ratio = 2.2) were higher after simultaneous bilateral total knee replacement. The prevalence of deep venous thrombosis was lower after simultaneous bilateral total knee replacement, but this difference was not significant. The complication rates after the staged bilateral total knee replacements were similar to those in the patients who had undergone unilateral total knee replacement only.
Compared with staged bilateral or unilateral total knee replacement, simultaneous bilateral total knee replacement carries a higher risk of serious cardiac complications, pulmonary complications, and mortality. The period of time between staged procedures that would eliminate these increased risks could not be determined from this study.
Therapeutic Level III.
同期双侧全膝关节置换术的安全性仍存在争议。一些研究表明，双侧手术术后严重并发症（包括死亡）的发生率较高，而其他研究则表明并发症发生率并未增加。本荟萃分析的目的是比较同期双侧全膝关节置换术与分期双侧及单侧全膝关节置换术的安全性。
进行计算机文献检索，以识别1966年至2005年间所有关于双侧全膝关节置换术的文献。获取所有英文摘要。然后进行多阶段评估，以确定符合该研究纳入标准的文章。纳入所有报告双侧全膝关节置换术结果的随机前瞻性研究。提取报告数据的详细信息，并对相关变量进行广泛分析。
共识别出150篇已发表文章，其中18篇（共纳入27,884例患者的44,684个膝关节）纳入荟萃分析。其中有10,930例单侧全膝关节置换术、16,419例同期双侧全膝关节置换术以及458例分期双侧全膝关节置换术（手术间隔至少3个月）。同期双侧全膝关节置换术后肺栓塞（优势比=1.8）、心脏并发症（优势比=2.49）和死亡率（优势比=2.2）的发生率较高。同期双侧全膝关节置换术后深静脉血栓形成的发生率较低，但差异不显著。分期双侧全膝关节置换术后的并发症发生率与仅接受单侧全膝关节置换术的患者相似。
与分期双侧或单侧全膝关节置换术相比，同期双侧全膝关节置换术发生严重心脏并发症、肺部并发症和死亡的风险更高。本研究无法确定分期手术之间的时间间隔，以消除这些增加的风险。
治疗性III级。
