Amit Priyadarshi, Marya S K S
Department of Orthopaedics and Joint Replacement, Max Smart Super Speciality Hospital, Saket, New Delhi, 110017, India.
Department of Trauma & Orthopaedics, Barts Health NHS Trust, Whitechapel, Lodon, E11FR, UK.
Arch Orthop Trauma Surg. 2022 Apr;142(4):657-663. doi: 10.1007/s00402-021-03841-z. Epub 2021 Mar 13.
The aim of this study was to validate the age-adjusted Charlson comorbidity index as a clinical practice guideline for patient selection between unilateral total knee arthroplasty (UTKA) and bilateral simultaneous total knee arthroplasty (BSTKA).
A consecutive series of 1016 patients undergoing UTKA (402 patients) or BSTKA (614 patients) was analysed. The age-adjusted Charlson comorbidity index (ACCI) was measured for all the patients and graded as low (0-2 score), moderate (3-4 score) and high risk (≥ 5 score). The complications occurring within 3 months of surgery were compared between UTKA and BSTKA recipients.
Following surgery, the complication rate was comparable between both the groups. However, among high-risk patients, there was significant difference in the complication rates between UTKA and BSTKA groups (12% versus 30.76%, minor; 8% versus 23.07%, major complication). The high-risk patients who had bilateral surgery were at more than three times greater risk of developing major and minor complications than those who had unilateral surgery.
The BSTKA procedure is associated with significantly higher risk of post-operative complications than UTKA procedure in patients with ≥ 5 ACCI scores.
本研究的目的是验证年龄校正的查尔森合并症指数作为单侧全膝关节置换术（UTKA）和双侧同期全膝关节置换术（BSTKA）患者选择的临床实践指南。
分析了连续的1016例行UTKA（402例患者）或BSTKA（614例患者）的患者。对所有患者测量年龄校正的查尔森合并症指数（ACCI），并分为低风险（0 - 2分）、中度风险（3 - 4分）和高风险（≥5分）。比较UTKA和BSTKA接受者在术后3个月内发生的并发症。
手术后，两组的并发症发生率相当。然而，在高风险患者中，UTKA组和BSTKA组的并发症发生率存在显著差异（轻微并发症：12%对30.76%；严重并发症：8%对23.07%）。接受双侧手术的高风险患者发生主要和轻微并发症的风险比接受单侧手术的患者高出三倍多。
在ACCI评分≥5分的患者中，BSTKA手术术后并发症风险显著高于UTKA手术。
