Department of Orthopedics Surgery, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China.
Core Facilities of West China Hospital, Sichuan University, Chengdu, China.
Orthop Surg. 2023 May;15(5):1249-1255. doi: 10.1111/os.13684. Epub 2023 Feb 16.
The implications of the interval of staged bilateral total knee arthroplasty (TKA) procedures for postoperative complications and costs are not clear. We aimed to determine the optimal time interval between the two stages of bilateral TKA procedures under the enhanced recovery after surgery (ERAS) protocol.
This retrospective study of collected data included bilateral TKA cases under the ERAS protocol performed between 2018 and 2021 at the West China Hospital of Sichuan University. The staged time was subdivided into three groups according to the interval between the first TKA and second contralateral TKA: group 1: 2- to 6-month, group 2: 6- to 12-month, and group 3: >12 months. The primary outcome was the incidence of postoperative complications. The secondary outcomes were the length of hospital stay (LOS), hemoglobin (Hb) decrease, hematocrit (Hct) decrease, and albumin (Alb) decrease.
We analyzed 281 patients who underwent staged bilateral TKAs between 2018 and 2021 at the West China Hospital of Sichuan University. Regarding postoperative complications, there were no statistically significant differences among the three groups (P = 0.21). For the mean LOS, the 6- to 12-month group had a significantly shorter LOS compared with the 2- to 6-month group (P < 0.01). There was also a significant decrease in Hct of the 2- to 6-month group compared with the 6- to 12-month group and the >12 months group (P = 0.02; P < 0.05, respectively).
Staging the second arthroplasty for more than a half year seems to offer a reduction in the rate of postoperative complications and LOS under ERAS protocol. ERAS shortens the interval of staged bilateral TKA by at least 6 months for patients who might receive their second surgery without the need to wait for an extended period.
分期双侧全膝关节置换术（TKA）手术的间隔时间对术后并发症和成本的影响尚不清楚。我们旨在确定增强术后康复（ERAS）方案下双侧 TKA 手术两阶段之间的最佳时间间隔。
这是一项回顾性研究，收集了 2018 年至 2021 年期间在四川大学华西医院接受 ERAS 方案下双侧 TKA 的病例。根据第一次 TKA 和第二次对侧 TKA 之间的间隔时间，分期时间分为三组：组 1：2-6 个月，组 2：6-12 个月，组 3：>12 个月。主要结果是术后并发症的发生率。次要结果是住院时间（LOS）、血红蛋白（Hb）下降、红细胞压积（Hct）下降和白蛋白（Alb）下降。
我们分析了 2018 年至 2021 年期间在四川大学华西医院接受分期双侧 TKA 的 281 例患者。关于术后并发症，三组之间无统计学差异（P=0.21）。对于平均 LOS，6-12 个月组的 LOS 明显短于 2-6 个月组（P<0.01）。与 6-12 个月组和>12 个月组相比，2-6 个月组的 Hct 也明显下降（P=0.02；P<0.05）。
在 ERAS 方案下，将第二次关节置换术分期超过半年似乎可以降低术后并发症和 LOS 的发生率。ERAS 将分期双侧 TKA 的间隔缩短至少 6 个月，使那些可能不需要等待延长时间即可接受第二次手术的患者受益。
