Staging Bilateral Total Knee Arthroplasties Reduces Alignment Outliers

Published:January 08, 2022DOI:https://doi.org/10.1016/j.arth.2022.01.003

      Abstract

      Purpose

      Patients frequently present with bilateral symptomatic knee osteoarthritis and request simultaneous total knee arthroplasties (TKAs). Technical differences between simultaneous and staged TKAs could affect clinical and radiographic outcomes. We hypothesized staged TKAs would have fewer mechanical alignment outliers than simultaneous TKAs.

      Methods

      We reviewed 87 simultaneous and 72 staged TKAs with at least 2 years of follow-up. Radiographic assessment was done using standing long leg and lateral radiographs of the knee. Coronal and sagittal measurements were performed by four blinded observers on two separate occasions with an intra-observer agreement of 0.95 and inter-observer of 0.92.

      Results

      The first simultaneous knee had no difference in the probability of establishing the mechanical axis outside 3° of neutral (45%) compared to the first staged knee (54%, p = 0.337). However, the second simultaneous knee (49%) was more likely to establish the axis outside mechanical neutral compared to the second staged knee (28%; Odds Ratio (OR): 2.54, Confidence Interval (CI): 1.31 - 4.94, p = 0.006). There was an increased risk of deep venous thrombosis with staged TKA (OR: 2.96, CI: 1.28 - 6.84, p = 0.011), but other perioperative complication rates were not significantly different. There were no clinically significant differences in range of motion or Knee Society Score.

      Conclusion

      There is a significantly increased risk of establishing the second knee outside mechanical neutral during a simultaneous TKA compared to staged bilateral TKAs, possibly related to a number of surgeon- and system-related factors. The impact on clinical outcomes and radiographic loosening may become significant in long-term follow up.

      Keywords

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