Systematic Reviews
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Nov 18, 2022; 13(11): 1029-1037
Published online Nov 18, 2022. doi: 10.5312/wjo.v13.i11.1029
Patient-reported dissatisfaction following second side in staged bilateral total knee arthroplasty: A systematic review
Eric Gruenberger, Andrew S Bae, Tyler Kelly, Brent A Ponce, James McGrory
Eric Gruenberger, Tyler Kelly, Brent A Ponce, The Hughston Foundation, Columbus, GA 31909, United States
Andrew S Bae, Department of Orthopedic Surgery, Jack Hughston Memorial Hospital, Phenix City, AL 36867, United States
James McGrory, Department ofOrthopedic Surgery, Hughston Foundation and Jack Hughston Memorial Hospital, Columbus, GA 31909, United States
Author contributions: Gruenberger E and Bae AS contributed to data collection, data analysis, and manuscript writing; McGrory J contributed to study design, manuscript writing, and revisions; Ponce BA contributed to study design; Kelly T contributed to data analysis and manuscript revisions.
Conflict-of-interest statement: The authors report that they have no conflicting interests.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Eric Gruenberger, MD, Research Fellow, The Hughston Foundation, 6262 Veterans Parkway, Columbus, GA 31909, United States. ehgruenberger@gmail.com
Received: May 6, 2022
Peer-review started: May 6, 2022
First decision: August 1, 2022
Revised: August 16, 2022
Accepted: October 5, 2022
Article in press: October 5, 2022
Published online: November 18, 2022
Processing time: 193 Days and 11.7 Hours
Abstract
BACKGROUND

Around one third of patients who undergo total knee arthroplasty (TKA) will eventually have the contralateral knee replaced. Overall patient satisfaction after staged bilateral total knee arthroplasty procedures performed on different days is reportedly similar to unilateral TKA. Nevertheless, in our anecdotal experience patients often report less satisfying outcomes following the second side. A cursory review of available literature tended to confirm that observation. We sought therefore to consolidate all of the available data on this issue to further investigate this phenomenon.

AIM

To consolidate available published data revealing satisfaction scores among patients following staged bilateral TKA, and to evaluate the phenomenon of less satisfying results following TKA2.

METHODS

A systematic review of available literature reporting on satisfaction with TKA1 and TKA2 after staged bilateral knee arthroplasty was undertaken using PubMed, Google Scholar, and Embase. From 427 records, five full-length articles met criteria for inclusion in the meta-analysis. The data were then extracted and assessed on the basis of the Reference Citation Analysis (https://www.referencecitationanalysis.com/).

RESULTS

A total of 1889 patients with an average age of 68 (range: 38–92) underwent staged bilateral TKA with outcomes reported at 1 year following each TKA with a mean 21.9 mo between surgeries (range: 2 d to 14.5 years). Overall satisfaction with both knees was 83.70% (1581) and dissatisfaction with both knees was 2.75% (52). In the remaining 13.56% (256) who were dissatisfied with one side, 61.0% were dissatisfied with TKA2, and 39.0% were dissatisfied with TKA1. Patient-reported outcome scores for TKA2 were frequently lower than TKA1 even in patients reporting overall satisfaction with both knees.

CONCLUSION

At 1-year follow-up, there was a 50% greater risk of dissatisfaction with TKA2 among the 13.56% of patients reporting dissatisfaction in one knee after staged bilateral TKA. Whether the interval between procedures or long-term follow-up changes these results requires further investigation.

Keywords: Staged, Staggered, Sequential, Bilateral arthroplasty, Total knee arthroplasty, Patient-reported outcomes

Core Tip: Total knee arthroplasty (TKA) is one of the most popular and successful treatments for end stage arthritis worldwide. Around one third of patients who undergo TKA will eventually have the contralateral knee replaced. Anecdotal experience has shown that patients tend to report decreased satisfaction following the second TKA procedure (TKA2). The primary aim of this review article was to assess patient satisfaction following TKA2 after staged bilateral knee arthroplasty. Ideally, quantifying reported dissatisfaction as well as reporting associated factors.