Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, New York.
J Arthroplasty. 2024 Jan;39(1):49-53. doi: 10.1016/j.arth.2023.06.025. Epub 2023 Jun 17.
In patients who require bilateral total hip arthroplasty (THA) or total knee arthroplasty (TKA), staged procedures are a reasonable option for treatment of bilateral osteoarthritis. We sought to determine whether perioperative outcomes differed between first and second total joint arthroplasty (TJA).
This was a retrospective review of all patients who underwent staged, bilateral THA or TKA between January 30, 2017, and April 8, 2021. All patients who were included underwent their second procedure within 1 year of the first. Patients were separated based on whether both their procedures took place before or subsequently after an institution-wide opioid-sparing protocol that was implemented on October 1, 2018. A total of 961 patients who underwent 1,922 procedures met the inclusion criteria for this study. For THA, 388 unique patients comprised 776 procedures, while 573 unique patients comprised 1,146 TKAs. Opioid prescriptions were prospectively documented on nursing opioid administration flowsheets and converted to morphine milligram equivalents (MME) for comparison. Activity measure scores for postacute care (AM-PAC) were used as a measurement of physical therapy progression.
Hospital stays, home discharges, perioperative opioid usages, pain scores, and AM-PAC scores were not significantly different for the second THA or TKA compared to first procedure, regardless of timing in relation to the opioid-sparing protocol.
Patients experienced similar outcomes following their first versus their second TJA. Limited opioid prescriptions following TJA do not negatively impact pain and functional outcomes. These protocols can safely be instituted to help mitigate the opioid epidemic.
Retrospective Cohort Study.
对于需要双侧全髋关节置换术（THA）或全膝关节置换术（TKA）的患者，分期手术是治疗双侧骨关节炎的合理选择。我们旨在确定初次和第二次全关节置换术（TJA）之间的围手术期结果是否存在差异。
这是一项对 2017 年 1 月 30 日至 2021 年 4 月 8 日期间接受分期双侧 THA 或 TKA 的所有患者进行的回顾性研究。所有纳入的患者均在初次手术后 1 年内进行第二次手术。患者根据第二次手术是在机构范围内的阿片类药物节约方案（于 2018 年 10 月 1 日实施）实施之前或之后进行进行分组。共有 961 名患者接受了 1922 次手术，符合本研究的纳入标准。THA 中有 388 名独特患者包括 776 次手术，573 名独特患者包括 1146 次 TKA。阿片类药物处方在护理阿片类药物管理流程表中进行了前瞻性记录，并转换为吗啡毫克当量（MME）进行比较。用于急性后护理的活动测量评分（AM-PAC）用于衡量物理治疗进展。
无论与阿片类药物节约方案的时间关系如何，第二次 THA 或 TKA 与初次手术相比，住院时间、家庭出院、围手术期阿片类药物使用、疼痛评分和 AM-PAC 评分均无显著差异。
患者在接受第一次与第二次 TJA 后获得了相似的结果。TJA 后开具的有限阿片类药物处方不会对疼痛和功能结果产生负面影响。这些方案可以安全实施，以帮助减轻阿片类药物流行。
III 级回顾性队列研究。
