Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei, 112, Taiwan.
Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Arch Orthop Trauma Surg. 2024 Aug;144(8):3591-3597. doi: 10.1007/s00402-024-05435-x. Epub 2024 Jul 8.
The choice between simultaneous and staged bilateral total knee arthroplasty (BTKA) remains controversial. Age-adjusted Charlson Comorbidity Index(CCI) is a promising tool for risk-stratification. We aimed to compare the outcomes between patients who underwent simultaneous and staged BTKA, stratified by age-adjusted CCI scores.
We conducted this retrospective, single-surgeon case series from 2010 to 2020. This study consisted of 1558 simultaneous BTKA and 786 staged BTKA procedures. The outcome domains included 30-day and 90-day readmission and 1-year reoperation events. We performed multivariate regression analysis to compare the risk of readmission and reoperation following simultaneous and staged BTKA. Other factors included age, sex, body mass index, diabetes mellitus, rheumatoid arthritis, smoking, receiving thromboprophylaxis and blood transfusion.
The rates of 30-day, 90-day readmission and 1-year reoperation following simultaneous BTKA was 1.99%, 2.70% and 0.71%, respectively. The rates of 30-day, 90-day readmission and 1-year reoperation following staged BTKA was 0.89%, 1.78% and 0.89%, respectively. For patients with age-adjusted CCI ≥ 4 points, simultaneous BTKA was associated with a higher risk of 30-day (aOR:3.369, 95% CI:0.990-11.466) and 90-day readmission (aOR:2.310, 95% CI:0.942-5.668). In patients with age-adjusted CCI ≤ 3 points, the risk of readmission and reoperation was not different between simultaneous or staged BTKA.
Simultaneous BTKA was associated with an increased risk of short-term readmissions in patients with age-adjusted CCI ≥ 4 points but not in those with age-adjusted CCI ≤ 3 points. Age-adjusted CCI can be an effective index for the choice between simultaneous and staged BTKA procedures.
同期双侧全膝关节置换术（BTKA）与分期双侧 BTKA 的选择仍存在争议。年龄调整 Charlson 合并症指数（CCI）是一种有前途的风险分层工具。我们旨在比较按年龄调整 CCI 评分分层的同期和分期 BTKA 患者的结局。
我们进行了这项回顾性、单外科医生病例系列研究，时间为 2010 年至 2020 年。本研究包括 1558 例同期 BTKA 和 786 例分期 BTKA 手术。结果领域包括 30 天和 90 天再入院和 1 年再次手术事件。我们进行了多变量回归分析，以比较同期和分期 BTKA 后再入院和再次手术的风险。其他因素包括年龄、性别、体重指数、糖尿病、类风湿关节炎、吸烟、接受血栓预防和输血。
同期 BTKA 后 30 天、90 天再入院和 1 年再次手术的发生率分别为 1.99%、2.70%和 0.71%。分期 BTKA 后 30 天、90 天再入院和 1 年再次手术的发生率分别为 0.89%、1.78%和 0.89%。对于年龄调整 CCI≥4 分的患者，同期 BTKA 与 30 天（aOR：3.369，95%CI：0.990-11.466）和 90 天再入院（aOR：2.310，95%CI：0.942-5.668）的高风险相关。对于年龄调整 CCI≤3 分的患者，同期或分期 BTKA 之间的再入院和再次手术风险无差异。
对于年龄调整 CCI≥4 分的患者，同期 BTKA 与短期再入院风险增加相关，但对于年龄调整 CCI≤3 分的患者则不然。年龄调整 CCI 可作为同期和分期 BTKA 手术选择的有效指标。
