Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York, USA.
Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Bone Joint J. 2021 Jun;103-B(6 Supple A):108-112. doi: 10.1302/0301-620X.103B6.BJJ-2020-2102.R1.
Many patients undergoing total knee arthroplasty (TKA) have severe osteoarthritis (OA) in both knees and may consider either simultaneous or staged bilateral TKA. The implications of simultaneous versus staged bilateral TKA for return to work are not well understood. We hypothesized that employed patients who underwent simultaneous bilateral TKA would have significantly fewer days missed from work compared with the sum of days missed from each operation for patients who underwent staged bilateral TKA.
The prospective arthroplasty registry at the Hospital for Special Surgery was used. Baseline characteristics and patient-reported outcome scores were evaluated. We used a linear regression model, adjusting for potential confounding variables including age, sex, preoperative BMI, and type of work (sedentary, moderate, high activity, or strenuous), to analyze time lost from work after simultaneous compared with staged bilateral TKA.
We identified 152 employed patients who had undergone simultaneous bilateral TKA and 61 who had undergone staged bilateral TKA, and had completed the registry's return to work questionnaire. The simultaneous group missed a mean of 46.2 days (SD 29.1) compared with the staged group who missed a mean total of 68.0 days of work (SD 46.1) when combining both operations. This difference was statistically significant (p < 0.001). In multivariate mixed regression analysis adjusted for age, sex, BMI, American Society of Anesthesiologists status, and type of work, the simultaneous group missed a mean of 16.9 (SD 5.7) fewer days of work compared with the staged group (95% confidence interval 5.8 to 28.1; p = 0.003).
Employed patients undergoing simultaneous bilateral TKA missed a mean of 17 fewer days of work as a result of their surgical treatment and rehabilitation compared with those undergoing staged bilateral TKA. This information may be useful to surgeons counselling employed patients with bilateral OA of the knee who are considering surgical treatment. Cite this article: 2021;103-B(6 Supple A):108-112.
许多接受全膝关节置换术（TKA）的患者双膝均患有严重骨关节炎（OA），可能会考虑同时或分期双侧 TKA。同时进行双侧 TKA 与分期双侧 TKA 对重返工作岗位的影响尚不清楚。我们假设同时进行双侧 TKA 的患者比分期进行双侧 TKA 的患者从每一次手术中错过的天数之和，从工作中恢复的天数要少。
使用特殊外科医院的前瞻性关节置换登记处。评估基线特征和患者报告的结果评分。我们使用线性回归模型，调整了潜在的混杂变量，包括年龄、性别、术前 BMI 和工作类型（久坐、中度、高度活跃或剧烈），来分析同时进行双侧 TKA 与分期进行双侧 TKA 后失去工作的时间。
我们确定了 152 名接受同时进行双侧 TKA 的在职患者和 61 名接受分期进行双侧 TKA 的患者，并完成了登记处的重返工作问卷。同时组平均错过 46.2 天（SD 29.1），而分期组在两次手术合并时平均总共错过 68.0 天的工作（SD 46.1）。这一差异具有统计学意义（p < 0.001）。在调整年龄、性别、BMI、美国麻醉医师协会状态和工作类型的多变量混合回归分析中，同时组平均比分期组少错过 16.9 天的工作（SD 5.7；95%置信区间 5.8 至 28.1；p = 0.003）。
与分期进行双侧 TKA 的患者相比，接受同时进行双侧 TKA 的患者由于手术治疗和康复，平均少错过 17 天的工作。这些信息可能对接受双侧膝关节 OA 手术治疗的患者有帮助。引用本文：2021；103-B（6 增刊 A）：108-112。
