Wu Christine Jiang, Penrose Colin, Ryan Sean Patrick, Bolognesi Michael Paul, Seyler Thorsten Markus, Wellman Samuel Secord
Department of Orthopaedic Surgery, Duke University Hospital, Durham, NC 27710, United States.
Department of Orthopaedic Surgery, Midwest Center for Joint Replacement, Indianapolis, IN 46241, United States.
World J Orthop. 2024 Mar 18;15(3):230-237. doi: 10.5312/wjo.v15.i3.230.
With the increasing incidence of total joint arthroplasty (TJA), there is a desire to reduce peri-operative complications and resource utilization. As degenerative conditions progress in multiple joints, many patients undergo multiple procedures.
To determine if both physicians and patients learn from the patient's initial arthroplasty, resulting in improved outcomes following the second procedure.
The institutional database was retrospectively queried for primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). Patients with only unilateral THA or TKA, and patients undergoing same-day bilateral TJA, were excluded. Patient demographics, comorbidities, and implant sizes were collected at the time of each procedure and patients were stratified by first second surgery. Outcome metrics evaluated included operative time, length of stay (LOS), disposition, 90-d readmissions and emergency department (ED) visits.
A total of 642 patients, including 364 undergoing staged bilateral TKA and 278 undergoing bilateral THA, were analyzed. There was no significant difference in demographics or comorbidities between the first and second procedure, which were separated by a mean of 285 d. For THA and TKA, LOS was significantly less for the second surgery, with 66% of patients having a shorter hospitalization ( < 0.001). THA patients had significantly decreased operative time only when the same sized implant was utilized ( = 0.025). The vast majority (93.3%) of patients were discharged to the same type of location following their second surgery. However, when a change in disposition was present from the first surgery, patients were significantly more likely to be discharged to home after the second procedure ( = 0.033). There was no difference between procedures for post-operative readmissions ( = 0.438) or ED visits ( = 0.915).
After gaining valuable experience recovering from the initial surgery, a patient's perioperative outcomes are improved for their second TJA. This may be the result of increased confidence and decreased anxiety, and it supports the theory that enhanced patient education pre-operatively may improve outcomes. For the surgical team, the second procedure of a staged THA is more efficient, although this finding did not hold for TKA.
随着全关节置换术（TJA）发病率的上升，人们希望减少围手术期并发症和资源利用。随着多个关节的退行性病变进展，许多患者需要接受多次手术。
确定医生和患者是否能从患者的初次关节置换术中吸取经验，从而使第二次手术的结果得到改善。
对机构数据库进行回顾性查询，以获取初次全髋关节置换术（THA）和全膝关节置换术（TKA）的相关信息。排除仅接受单侧THA或TKA的患者以及同日接受双侧TJA的患者。在每次手术时收集患者的人口统计学资料、合并症和植入物尺寸，并根据首次和第二次手术对患者进行分层。评估的结果指标包括手术时间、住院时间（LOS）、出院情况、90天再入院率和急诊就诊情况。
共分析了642例患者，其中364例接受分期双侧TKA，278例接受双侧THA。首次和第二次手术之间的人口统计学资料或合并症无显著差异，两次手术间隔的平均时间为285天。对于THA和TKA，第二次手术的LOS显著缩短，66%的患者住院时间更短（P<0.001）。仅当使用相同尺寸的植入物时，THA患者的手术时间显著缩短（P=0.025）。绝大多数（93.3%）患者在第二次手术后出院至同一类型的场所。然而，当出院情况与首次手术不同时，患者在第二次手术后出院回家的可能性显著更高（P=0.033）。术后再入院率（P=0.438）或急诊就诊情况（P=0.915）在不同手术之间无差异。
在从初次手术中获得宝贵的恢复经验后，患者第二次TJA的围手术期结果得到改善。这可能是信心增强和焦虑减轻所致，也支持术前加强患者教育可能改善结果这一理论。对于手术团队而言，分期THA的第二次手术效率更高，尽管这一发现不适用于TKA。
