Comparison of the major intraoperative and postoperative complications between unilateral and sequential bilateral total knee arthroplasty in a high-volume community hospital

• Published in: Canadian Journal of Surgery 2013-10, Vol.56 (5), p.311-317
• Main Authors: Spicer, Erin, MSc, Thomas, Garry Robert, MSc, Rumble, Edward John, MD
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Arthritis; Arthroplasty, Replacement, Knee - methods; Blood Loss, Surgical - statistics & numerical data; Comorbidity; Complications; Female; Hospitals, Community; Hospitals, High-Volume; Humans; Intraoperative Complications - epidemiology; Joint surgery; Male; Middle Aged; Ontario; Osteoarthritis, Knee - epidemiology; Patient safety; Postoperative Complications - epidemiology; Studies; Surgery; Surgical outcomes; Surgical techniques; Surgical Wound Infection - epidemiology; Thromboembolism - epidemiology
• ISSN: 0008-428X; 1488-2310
• DOI: 10.1503/cjs.012912

Background Total knee arthroplasty (TKA) is a common surgical treatment for arthritis. In the event of bilateral knee symptoms, a patient may elect for bilateral TKA (BTKA) under 1 anesthetic or 2 separate unilateral TKAs (UTKA). Controversy exists in the literature regarding the safety of BTKA versus UTKA. We compared the rate of major intraoperative and postoperative complications for BTKA versus UTKA at a high-volume community hospital. Methods We compared 373 patients who underwent BTKA with 966 who underwent UTKA between May 2008 and May 2011. Health records were used to determine patient characteristics and major intraoperative and postoperative complications. The BTKA and UTKA cohorts were matched for demographic characteristics and comorbidities with the exception of previous transient ischemic attack and previous knee surgery (UTKA > BTKA). Results Rates of intraoperative and postoperative complications, including cardiovascular, thromboembolic and neurologic complications; deep wound infections; and mortality, did not differ significantly between groups. Bilateral TKA was associated with a greater proportion of patients requiring blood transfusion than UTKA (29.8% v. 8.9%, p < 0.001). Among those transfused, there was no significant difference between the groups in the mean number of units required (1.72 ± 0.77 v. 1.53 ± 0.85 units, p = 0.68). Conclusion Bilateral TKA was not associated with statistically greater rates of intra-operative and postoperative complications than UTKA, barring the proportion of patients requiring transfusion. Our results support the use of BTKA to treat bilateral knee arthritis in a high-volume community hospital setting.