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Tuesday, March 16, 2000

BTKA adds slightly higher risk for older patients

Sequential bilateral total knee arthroplasty (BTKA) is an accepted procedure for patients with symptomatic bilateral disease, but researchers in scientific exhibit 39 wanted to look at the safety and impact on the well being of older patients in comparison with similar issues among older patients who underwent unilateral total knee arthroplasty (UTKA).

They found BTKA adds a slight statistically significant increase in perioperative complications (within 30 days) in pulmonary and GI disease. However, the overall safety or negative impact on medical well being is not greatly different in the two groups.

Between 1990 and 1998, the researchers reviewed 147 UTKA and 147 BTKA cases done at Lutheran General Hospital in Park Ridge, Ill. and analyzed patients for major preoperative comorbidity, perioperative complications (within 30 days of OR) and late complications (to 1 year). A sequential BTKA is defined as a second total knee arthroplasty done after the completion of the first during the same anesthesia.

Comorbidities included cardiovascular, pulmonary, gastrointestinal, thromboembolic disease, neurologic, genitourinary, anemia, endocrine and carcinoma diseases.

The average age of BTKA patients was 79 and of UTKA patients, 80. There were 51 males and 96 females in each group. In BTKA, 143 patients had osteoarthritis and four, rheumatoid arthritis. In UTKA 137 patients had osteoarthritis; four, avascular necrosis; four, rheumatoid arthritis; one, post-traumatic; and one, inflammatory. Average length of stay was four days in UTKA and 4.9 in BTKA. Blood transfusions were given to 99 BTKA patients (average 1.56 units) and 39 UTKA (average 0.39 units) patients.

Fifteen BTKA patients were admitted to ICU compared to five UTKA patients. Twenty-nine percent of UTKA patients had either prior or subsequent TKA on the other side. No statistically significant difference was found in preoperative comoribidites, except for coexisting musculoskeletal disease in UTKA. Forty-five of 147 patients had at least one perioperative complication in BTKA and 27 of 147 patients in UTKA (statistically significant). Eleven pulmonary complications were found in BTKA patients vs. three in UTKA patients; 13 GI complications were found in BTKA patients versus one in UTKA, both cases were significant.

No statistically significant differences occurred in thromboembolic, neurologic or cardiovascular diseases. Fourteen cases of transient idiopathic hypoxia or confusion occurred in both groups. Late complications occured in 31 of 147 patients in UTKA and 30 of 147 patients in BTKA. The total number of late complications was 54 in UTKA and 40 in BTKA. Two late deaths occurred the BTKA group (one unrelated) and one in the UTKA group.

Two deep infections occurred in UTKA patients, none in BTKA. Subsequent symptomatic musculoskeletal diseases were higher in UTKA (statistically significant). No differences in thromboembolic events (five in BTKA patients--four early, one late; four in UTKA patients--two early, two late) was found. Three perioperative strokes and two late strokes occurred in BTKA patients and one perioperative stroke in UTKA patients; there were no late strokes in UTKA patients.

The researchers are Rod Comisar, MD, resident; and Wayne M. Goldstein, MD, chief, division of orthopaedic surgery, Lutheran General Hospital, Illinois Bone and Joint Institute, Park Ridge, Ill.

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Last modified 23/February/2000 by IS