Published online Jan 18, 2022. doi: 10.5312/wjo.v13.i1.58
Peer-review started: April 28, 2021
First decision: October 17, 2021
Revised: October 28, 2021
Accepted: December 25, 2021
Article in press: December 25, 2021
Published online: January 18, 2022
Bilateral one-stage total knee arthroplasty (BTKA) is a notable option for patients with bilateral end-stage knee arthropathy because of the potential advantages that include reduction in total hospitalization and rehabilitation time, as well as overall cost.
Despite previously acknowledged benefits, there is an issue frequently concerning patients as to whether the intensity of pain and disablement during convalescence from BTKA is worse than that following unilateral total knee arthroplasty (UTKA). Also, the risk of cardiovascular morbidity and other complications are subjects that lead some surgeons to refrain from BTKA. Thus, our objective was to identify what perioperative aspects of BTKA need to be improved and handled differently than for UTKA.
To compare the perioperative outcomes including perioperative blood loss (PBL), cardiac biomarkers, pain intensity, functional recovery, and complications between UTKA and BTKA by using an identical perioperative protocol.
All patients who had undergone UTKA and BTKA for primary osteoarthritis that had been performed by a single surgeon with identical perioperative protocols between January 2016 and December 2019 were retrospectively reviewed. The exclusion criteria of this study included patients with an American Society of Anesthesiologists score > 3, known cardiopulmonary comorbidity or high-sensitivity Troponin-T (hs-TnT) > 14 ng/L, CKD stage ≥ 3 or significant renal impairment (serum creatinine > 1.5 mg/dL), prior knee surgery, and previous knee infection.
Patients who received BTKA had significantly higher PBL with a 4-fold greater transfusion rate. As well, the patients in the BTKA group had higher visual analogue scale scores at 48, 72, and 96 h after the surgery and a higher postoperative creatine phosphokinase level. Consequently, a longer length of hospital stays than those who had UTKA was required. However, there was no difference regarding the postoperative hs-TnT level and complications.
Patients who undergo BTKA may require more extensive perioperative care for blood loss and pain than those patients who undergo UTKA.
Future prospective studies may be required to develop a particular perioperative protocol in patients undergoing BTKA to decrease potential morbidity and mortality.