Department of Joint and Sports Medicine, Zaozhuang Municipal Hospital Affiliated to Jining Medical University, No.41 Longtou Road, Shizhong District, Zaozhuang, 277100, Shandong, China.
Department of Spine Surgery, Zaozhuang Municipal Hospital Affiliated to Jining Medical University, Zaozhuang, 277100, Shandong, China.
Adv Ther. 2021 Oct;38(10):5191-5208. doi: 10.1007/s12325-021-01880-x. Epub 2021 Aug 28.
To the authors' knowledge, there is no current consensus regarding the optimal interprocedural interval for patients who have undergone bilateral total knee arthroplasty (BTKA). The purpose of this study is to evaluate complication rates and functional outcome in patients who have undergone BTKA (simultaneous or sequential at different time intervals), and to determine an optimal time frame for the second knee.
Data from 315 patients who were able to tolerate simultaneous BTKA according to the anaesthesiologist's preoperative assessment between 2016 and 2020 were analysed retrospectively. According to the operative time interval, they were divided into simultaneous, ≤ 1-month sequential, 1- to 3-month sequential, and ≥ 3-month sequential BTKA groups. The primary outcomes were revision and readmission rates during the follow-up period, and the secondary outcomes were hospital length of stay (LOS), transfusion and postoperative complications.
There was no difference in the implant survival or readmission rate between the groups (p > 0.05). Multivariable linear regression showed that interprocedural interval and body mass index (BMI) affected LOS; the LOS of simultaneous BTKA was the shortest (p < 0.05). BMI was associated with an increased LOS of 0.25 days (95% CI 0.02-0.48, p = 0.03). A modified Poisson regression model showed that the odds of blood transfusion were reduced in sequential BTKAs of any interval (p < 0.05), and preoperative haemoglobin (Hb) was also a risk factor (RR 0.96, 95% CI 0.95-0.98, p < 0.001). The interprocedural interval was not a risk factor for postoperative cardiovascular and cerebrovascular complications.
For appropriate patients, simultaneous BTKA is beneficial. However, higher preoperative haemoglobin was required to mitigate the high blood transfusion rate associated with simultaneous surgeries. If suitable patients refuse simultaneous BTKA for other non-medical reasons, sequential BTKA with an interval greater than 1 month is recommended.
据作者所知，目前对于行双侧全膝关节置换术（BTKA）的患者，尚无关于最佳术间间隔的共识。本研究旨在评估行 BTKA（同期或不同时间间隔的序贯）的患者的并发症发生率和功能结局，并确定行第二膝关节手术的最佳时间框架。
回顾性分析了 2016 年至 2020 年间，根据麻醉医生术前评估能够耐受同期 BTKA 的 315 例患者的数据。根据手术时间间隔，将患者分为同期、≤1 个月序贯、1-3 个月序贯和≥3 个月序贯 BTKA 组。主要结局是随访期间的翻修和再入院率，次要结局是住院时间（LOS）、输血和术后并发症。
各组间的假体生存率或再入院率无差异（p＞0.05）。多变量线性回归显示术间间隔和体重指数（BMI）影响 LOS；同期 BTKA 的 LOS 最短（p＜0.05）。BMI 与 LOS 增加 0.25 天相关（95%CI 0.02-0.48，p=0.03）。改良泊松回归模型显示，任何间隔的序贯 BTKA 输血的可能性均降低（p＜0.05），术前血红蛋白（Hb）也是一个危险因素（RR 0.96，95%CI 0.95-0.98，p＜0.001）。术间间隔不是术后心血管和脑血管并发症的危险因素。
对于合适的患者，同期 BTKA 是有益的。但是，需要更高的术前血红蛋白来减轻同期手术相关的高输血率。如果合适的患者出于其他非医疗原因拒绝同期 BTKA，则建议间隔大于 1 个月的序贯 BTKA。
