RESEARCH - Safety of simultaneous bilateral total knee arthroplasty: a meta-analysis

[Guest guest]

J Bone Joint Surg Am. 2007 Jun;89(6):1220-6.

Safety of simultaneous bilateral total knee arthroplasty. A meta-analysis.

Restrepo C, Parvizi J, Dietrich T, Einhorn TA.

Department of Orthopedic Surgery, Rothman Institute at

Jefferson University Hospital, Philadelphia, Pennsylvania 19107, USA.

BACKGROUND: The safety of simultaneous bilateral total knee

replacement remains controversial. Some studies have demonstrated a

higher rate of serious complications, including death, following

bilateral procedures, whereas others have suggested no increase in the

complication rate. The objective of this meta-analysis was to compare

the safety of simultaneous bilateral total knee replacement with that

of staged bilateral and unilateral total knee replacements. METHODS: A

computerized literature search was conducted to identify all

citations, from 1966 to 2005, concerning bilateral total knee

replacement. All of the English-language abstracts were obtained. A

multistage assessment was then performed to identify articles

fulfilling the inclusion criteria for the study. All randomized,

prospective studies reporting the outcome of bilateral total knee

replacement were included. The details of the reported data were

extracted, and an extensive analysis of relevant variables was carried

out. RESULTS: One hundred and fifty published articles were

identified, and eighteen that included a total of 27,807 patients

(44,684 knees) were included in the meta-analysis. There were 10,930

unilateral total knee replacements, 16,419 simultaneous bilateral

total knee replacements, and 458 staged bilateral total knee

replacements with at least three months between the operative

procedures. The prevalences of pulmonary embolism (odds ratio = 1.8),

cardiac complications (odds ratio = 2.49), and mortality (odds ratio =

2.2) were higher after simultaneous bilateral total knee replacement.

The prevalence of deep venous thrombosis was lower after simultaneous

bilateral total knee replacement, but this difference was not

significant. The complication rates after the staged bilateral total

knee replacements were similar to those in the patients who had

undergone unilateral total knee replacement only.

CONCLUSIONS: Compared with staged bilateral or unilateral total knee

replacement, simultaneous bilateral total knee replacement carries a

higher risk of serious cardiac complications, pulmonary complications,

and mortality. The period of time between staged procedures that would

eliminate these increased risks could not be determined from this

study. LEVEL OF EVIDENCE: Therapeutic Level III.

PMID: 17545424

http://www.ncbi.nlm.nih.gov/pubmed/17545424

--

Not an MD