双侧同期全膝关节置换术即使在最健康的患者中也可能不安全。

Bilateral Simultaneous Total Knee Arthroplasty May Not Be Safe Even in the Healthiest Patients.

机构信息

Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.

Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, Florida.

出版信息

J Bone Joint Surg Am. 2021 Feb 17;103(4):303-311. doi: 10.2106/JBJS.20.01046.

DOI:10.2106/JBJS.20.01046

PMID:33369981

Abstract

BACKGROUND

Bilateral total knee arthroplasty (TKA) has been shown to increase both mortality and complications, but has potential benefits including decreased length of stay, rehabilitation time, and costs. The purpose of this study was to use data from a nationally representative database to identify if there is a population of patients undergoing TKA in whom bilateral TKA can be safely performed, by comparing 30-day mortality and complication rates with those of patients undergoing unilateral TKA.

METHODS

The National Surgical Quality Improvement Program (NSQIP) was queried to compare 30-day rates of mortality and any complication between bilateral TKA and unilateral TKA. A total of 8,291 patients who underwent bilateral TKA were matched 1:1 with a unilateral TKA control cohort (n = 315,219) by morbidity probability, which is a cumulative variable encompassing demographic characteristics, comorbidities, and laboratory values. Patients were divided into quartiles based on morbidity probability. Binary logistic regression comparing bilateral TKA and unilateral TKA for the same quartiles was performed to establish if any population could safely have bilateral TKA performed.

RESULTS

Bilateral TKA had an increased risk for all complications (p < 0.001) and major complications (p < 0.001) when compared with unilateral TKA regardless of health status. For all complications, there was a greater than threefold increase for the first quartile (healthiest patients) (p < 0.001), a greater than fourfold increase for the second and third quartiles (p < 0.001), and a greater than threefold increase for the fourth quartile (least healthy patients) (p < 0.001). For major complications, there was a greater than twofold increase for the first quartile (p = 0.001) and the second quartile (p < 0.001), an almost threefold increase for the third quartile (p < 0.001), and a 57% increase for the fourth quartile (p = 0.005).

CONCLUSIONS

This study will assist shared decision-making between orthopaedic surgeons and patients by suggesting that bilateral TKA may not be as safe an option for even healthy individuals compared with unilateral TKA.

LEVEL OF EVIDENCE

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

摘要

背景

双侧全膝关节置换术（TKA）已被证明会增加死亡率和并发症，但也有潜在的益处，包括缩短住院时间、康复时间和降低成本。本研究旨在利用来自全国代表性数据库的数据，通过比较双侧 TKA 和单侧 TKA 的 30 天死亡率和并发症发生率，确定是否存在可以安全进行双侧 TKA 的患者人群。

方法

通过国家手术质量改进计划（NSQIP）查询，比较双侧 TKA 和单侧 TKA 的 30 天死亡率和任何并发症发生率。通过发病率概率（一种包含人口统计学特征、合并症和实验室值的累积变量）将 8291 例双侧 TKA 患者与单侧 TKA 对照组（n=315219）进行 1:1 匹配。根据发病率概率将患者分为四组。对相同四分位数的双侧 TKA 和单侧 TKA 进行二元逻辑回归比较，以确定是否有任何人群可以安全地进行双侧 TKA。

结果

无论健康状况如何，与单侧 TKA 相比，双侧 TKA 的所有并发症（p<0.001）和主要并发症（p<0.001）风险均增加。对于所有并发症，第一四分位数（最健康的患者）的风险增加了三倍以上（p<0.001），第二和第三四分位数（p<0.001）的风险增加了四倍以上，第四四分位数（最不健康的患者）的风险增加了三倍以上（p<0.001）。对于主要并发症，第一四分位数（p=0.001）和第二四分位数（p<0.001）的风险增加了两倍以上，第三四分位数（p<0.001）的风险增加了近三倍，第四四分位数（p=0.005）的风险增加了 57%。