Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Mar 18, 2024; 15(3): 230-237
Published online Mar 18, 2024. doi: 10.5312/wjo.v15.i3.230
Subsequent total joint arthroplasty: Are we learning from the first stage?
Christine Jiang Wu, Colin Penrose, Sean Patrick Ryan, Michael Paul Bolognesi, Thorsten Markus Seyler, Samuel Secord Wellman
Christine Jiang Wu, Sean Patrick Ryan, Michael Paul Bolognesi, Thorsten Markus Seyler, Samuel Secord Wellman, Department of Orthopaedic Surgery, Duke University Hospital, Durham, NC 27710, United States
Colin Penrose, Department of Orthopaedic Surgery, Midwest Center for Joint Replacement, Indianapolis, IN 46241, United States
Author contributions: Wu CJ revised the manuscript; Penrose C performed the data collection and drafted manuscript; Ryan SP performed data collection and analysis and drafted manuscript; Bolognesi MP, Seyler TM, and Wellman SS designed the study and provided guidance; All authors approved the final manuscript.
Institutional review board statement: Institutional review board approval was obtained prior to initiation of the study.
Informed consent statement: Consent is waived per the Duke Institutional Review Board for this retrospective review study.
Conflict-of-interest statement: Colin Penrose and Christine Jiang Wu report no conflicts. Sean Patrick Ryan reports research support from Zimmer Biomet and Smith & Nephew, outside the submitted work. Michael Paul Bolognesi reports royalties from Total Joint Orthopaedics and Zimmer Biomet, stock options from Amedica, research support from Depuy Synthes, Exactech, PCORI, and financial support from Smith & Nephew, DJO, and Acelity, and research support from KCI, outside of this work. Thorsten Markus Seyler reports paid consultant work from Total Joint Orthopedics, Smith & Nephew, Heraeus Medical, and Peptilogics, research support from Zimmer Biomet, Royalties from Pattern Health, publishing royalties from Lippincott Williams & Wilkins, and IP royalties from Restor3d, outside the submitted work. Samuel Secord Wellman reports research support from Zimmer Biomet and DePuy Synthes, stock options from Joint Development, LLC, research support from Medacta, Smith & Nephew, Stryker, and royalties from Joint Orthopedics, outside the submitted work.
Data sharing statement: Per the institutional review board, consent was not obtained but the data are de-identified and risk of identification is low.
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: Christine Jiang Wu, MD, Surgeon, Department of Orthopaedic Surgery, Duke University Hospital, 311 Trent Drive, Durham, NC 27710, United States. christine.j.wu@duke.edu
Received: September 8, 2023
Peer-review started: September 8, 2023
First decision: December 12, 2023
Revised: January 15, 2024
Accepted: February 2, 2024
Article in press: February 2, 2024
Published online: March 18, 2024
Abstract
BACKGROUND

With the increasing incidence of total joint arthroplasty (TJA), there is a desire to reduce peri-operative complications and resource utilization. As degenerative conditions progress in multiple joints, many patients undergo multiple procedures.

AIM

To determine if both physicians and patients learn from the patient’s initial arthroplasty, resulting in improved outcomes following the second procedure.

METHODS

The institutional database was retrospectively queried for primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). Patients with only unilateral THA or TKA, and patients undergoing same-day bilateral TJA, were excluded. Patient demographics, comorbidities, and implant sizes were collected at the time of each procedure and patients were stratified by first vs second surgery. Outcome metrics evaluated included operative time, length of stay (LOS), disposition, 90-d readmissions and emergency department (ED) visits.

RESULTS

A total of 642 patients, including 364 undergoing staged bilateral TKA and 278 undergoing bilateral THA, were analyzed. There was no significant difference in demographics or comorbidities between the first and second procedure, which were separated by a mean of 285 d. For THA and TKA, LOS was significantly less for the second surgery, with 66% of patients having a shorter hospitalization (P < 0.001). THA patients had significantly decreased operative time only when the same sized implant was utilized (P = 0.025). The vast majority (93.3%) of patients were discharged to the same type of location following their second surgery. However, when a change in disposition was present from the first surgery, patients were significantly more likely to be discharged to home after the second procedure (P = 0.033). There was no difference between procedures for post-operative readmissions (P = 0.438) or ED visits (P = 0.915).

CONCLUSION

After gaining valuable experience recovering from the initial surgery, a patient’s perioperative outcomes are improved for their second TJA. This may be the result of increased confidence and decreased anxiety, and it supports the theory that enhanced patient education pre-operatively may improve outcomes. For the surgical team, the second procedure of a staged THA is more efficient, although this finding did not hold for TKA.

Keywords: Staged total joint arthroplasty, Asynchronous total joint arthroplasty, Subsequent total joint arthroplasty, Contralateral total joint arthroplasty, Perioperative outcomes

Core Tip: In this study, we investigated if surgeons and patients learn from their initial arthroplasty experience, resulting in improved outcomes following their second procedure. We showed that the second procedure of staged total hip arthroplasty has a shorter operative time, likely due to increased precision in implant sizing. However, this was not seen in total knee arthroplasty. After gaining valuable experience recovering from the initial surgery, a patient’s perioperative outcomes are improved for their second total joint arthroplasty with shorter length of stay and similar discharge to facility or increased change of discharge to home.