Omichi Yasuyuki, Goto Tomohiro, Momota Kaori, Sato Ryosuke, Sairyo Koichi, Nakano Shunji
Department of Orthopedics, Tokushima Municipal Hospital, 2-34 Kitajousanjima, Tokushima City, Tokushima, 770-0812, Japan.
Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima City, Tokushima, 770-8503, Japan.
Arch Orthop Trauma Surg. 2025 Mar 19;145(1):196. doi: 10.1007/s00402-025-05814-y.
This study compared complications and clinical outcomes between simultaneous bilateral total knee arthroplasty (SBTKA) and unilateral total knee arthroplasty (UTKA) across different age groups.
This retrospective single-center study included 939 consecutive patients aged 60-89 years who underwent primary total knee arthroplasty between 2019 and 2023. After applying propensity score matching for preoperative deep vein thrombosis (DVT), American Society of Anesthesiologists (ASA) classification, and preoperative functional activity according to the Knee Society Score 2011 (KSS) to 223 patients who underwent SBTKA and 716 patients who underwent UTKA, SBTKA and UTKA were compared in the following age groups: 60s (28 vs. 28), 70s (110 vs. 110), and 80s (60 vs. 60). Perioperative complications and clinical outcomes at 1 year after surgery were compared between SBTKA and UTKA. Lower limb Doppler ultrasound was performed to screen for asymptomatic DVT preoperatively and on postoperative day 7.
Average ASA classification ranged from 2.0 to 2.2 across all age groups, with no difference between SBTKA and UTKA. Compared with UTKA, the decrease in hemoglobin was significantly greater after SBTKA in patients in their 70s and 80s (both p < 0.001). The proportion of blood transfusion showed no significant difference across all age groups. Asymptomatic DVT was more frequent after SBTKA than after UTKA in patients in their 80s (58.3% vs. 40.0%, p < 0.045), but not those in their 60s (42.9% vs. 32.1%) or 70s (50.9% vs. 46.3%). Clinical outcomes (knee symptoms, patient satisfaction, patient expectations, functional activity according to the KSS) were comparable between SBTKA and UTKA across all age groups at 1 year postoperatively.
SBTKA had higher risk of asymptomatic DVT in patients in their 80s. With evaluation of risk factors and careful patient selection, SBTKA is a valid option in terms of safety and clinical outcomes in elderly patients with ASA 2.
本研究比较了不同年龄组同时双侧全膝关节置换术（SBTKA）和单侧全膝关节置换术（UTKA）的并发症及临床结局。
这项回顾性单中心研究纳入了2019年至2023年间连续接受初次全膝关节置换术的939例60 - 89岁患者。在对223例行SBTKA的患者和716例行UTKA的患者进行术前深静脉血栓形成（DVT）、美国麻醉医师协会（ASA）分级以及根据2011年膝关节协会评分（KSS）的术前功能活动进行倾向评分匹配后，对SBTKA和UTKA在以下年龄组进行比较：60多岁（28例对28例）、70多岁（110例对110例）和80多岁（60例对60例）。比较SBTKA和UTKA的围手术期并发症及术后1年的临床结局。术前及术后第7天进行下肢多普勒超声检查以筛查无症状DVT。
所有年龄组的平均ASA分级在2.0至2.2之间，SBTKA和UTKA之间无差异。与UTKA相比，70多岁和80多岁患者行SBTKA后血红蛋白下降明显更大（均p < 0.001）。所有年龄组的输血比例无显著差异。80多岁患者行SBTKA后无症状DVT比UTKA更常见（58.3%对40.0%，p < 0.045），但60多岁（42.9%对32.1%）和70多岁（50.9%对46.3%）患者并非如此。术后1年，所有年龄组SBTKA和UTKA的临床结局（膝关节症状、患者满意度、患者期望、根据KSS的功能活动）相当。
80多岁患者行SBTKA有更高的无症状DVT风险。通过评估危险因素并仔细选择患者，SBTKA对于ASA 2级老年患者在安全性和临床结局方面是一个有效的选择。
