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
ARTICLE HIGHLIGHTS
Research background

The volume of total joint arthroplasty is increasing rapidly and measures to decrease complications, increase efficiency and minimize resource utilization are important considerations.

Research motivation

The motivation for this project was to investigate if patients and surgeons learned or improved upon measures from the initial arthroplasty in subsequent contralateral procedures.

Research objectives

Our primary outcomes examined were operative time, length of stay, discharge disposition and 90-d emergency department visits and admissions. Length of stay was statistically significantly shorter. Total hip arthroplasty (THA) patients had a shorter operative time when the same implant sizes were utilized. There was no difference in 90-d hospital utilization.

Research methods

We utilized retrospective institutional database review for data collection and univariable analyses to compare cohorts.

Research results

Our results show that the second side of staged THA performed had shorter operative time, but there was no difference in total knee arthroplasty (TKA). There were no differences in postoperative hospital utilization. There was a shorter length of stay after the second procedure.

Research conclusions

This study reveals that patients had a shorter hospital stay after the second total joint arthroplasty (TJA) and operative time was statistically significantly shorter for the contralateral THA, but no difference was noted in TKA. This study seems to show that there is a benefit to pre and postoperative counseling in patient hospital stay and clinical course, and that there is a similar rate of postoperative hospital visits after the first and second TJA.

Research perspectives

Future studies may examine patient reported outcomes and experience of pain after first and second total joint arthroplasty, as well as if implant type or bearing type may affect patient reported outcomes or outcomes.