Lévy Yoann, Azar Michel, Tran Laurie, Boileau Pascal, Bronsard Nicolas, Trojani Christophe
Service de chirurgie orthopédique et chirurgie du sport, institut universitaire locomoteur et du sport (IULS), hôpital Pasteur 2, 30, voie Romaine, 06000 Nice, France.
Service d'anesthésie-réanimation, hôpital Pasteur 2, 30, voie Romaine, 06000 Nice, France.
Orthop Traumatol Surg Res. 2018 Dec;104(8):1199-1203. doi: 10.1016/j.otsr.2018.08.007. Epub 2018 Oct 9.
Single-stage bilateral total knee replacement (TKR) has the advantages of requiring only one hospital stay and one anesthesia session, having a shorter rehabilitation period, and reducing the cost of patient care. However, this strategy is controversial because of the perioperative risk. We hypothesized that this strategy did not cause early perioperative mortality and that the early morbidity and readmission rates would be low when patients are selected based on their ASA score.
This single-center retrospective study analyzed a cohort of ASA-1 and ASA-2 patients who underwent single-stage bilateral TKR over an 8-year period (2009 to 2016). The study cohort consisted of 116 patients, mainly women with mean age of 69 years at inclusion; 22.4% of patients were ASA-1 and 77.6% were ASA-2. Death and early complications during the first 90 days postoperative, the early readmission rate and the blood-sparing strategy were analyzed using the clinical and paraclinical data collected during the hospital stay, during the convalescent care center stay, and during the follow-up visits at 6 weeks and 3 months postoperative. The analysis was completed using the intrahospital software Clinicom, which allowed us to trace all the events and episodes for each patient.
The early mortality rate was 0%. There were five major complications (4.3%) and thirteen minor complications (11%). The early readmission rate was 5.2%. Homologous blood transfusion was performed in 36% of patients. Administration of tranexamic acid reduced this rate to 24.3% versus 44% in patients not taking it (p=0.06).
The perioperative mortality in this selected population is zero and the early morbidity is acceptable. The early readmission rate is also low. Thus proposing single-stage bilateral TKR to patients meeting the criteria defined in this study is a valid strategy.
IV, retrospective cohort study.
单阶段双侧全膝关节置换术（TKR）具有仅需一次住院和一次麻醉、康复期较短以及降低患者护理成本等优点。然而，由于围手术期风险，该策略存在争议。我们假设该策略不会导致围手术期早期死亡，并且当根据患者的美国麻醉医师协会（ASA）评分进行选择时，早期发病率和再入院率会较低。
这项单中心回顾性研究分析了一组在8年期间（2009年至2016年）接受单阶段双侧TKR的ASA - 1和ASA - 2患者。研究队列包括116名患者，主要为女性，纳入时平均年龄69岁；22.4%的患者为ASA - 1，77.6%为ASA - 2。使用住院期间、康复护理中心期间以及术后6周和3个月随访期间收集的临床和辅助临床数据，分析术后前90天的死亡和早期并发症、早期再入院率以及血液保护策略。使用医院内部软件Clinicom完成分析，该软件使我们能够追踪每位患者的所有事件和情况。
早期死亡率为0%。有5例主要并发症（4.3%）和13例次要并发症（11%）。早期再入院率为5.2%。36%的患者接受了同源输血。与未服用氨甲环酸的患者相比，服用氨甲环酸将该比例降至24.3%，而未服用者为44%（p = 0.06）。
该选定人群的围手术期死亡率为零，早期发病率可接受。早期再入院率也较低。因此，向符合本研究定义标准的患者提议单阶段双侧TKR是一种有效的策略。
IV，回顾性队列研究。
