Concurrent-, Staged-Bilateral Knee Arthroplasty Compared

Reduction in joint infection, malfunction, but increased CVD events with simultaneous procedure

THURSDAY, Dec. 15 (HealthDay News) -- Simultaneous-bilateral arthroplasty is associated with reduced incidence of periprosthetic joint infection and malfunction, and with increased cardiovascular risk, compared with staged-bilateral arthroplasty, according to a study published in the Dec. 7 issue of The Journal of Bone & Joint Surgery.

John P. Meehan, M.D., from the University of California in Davis, and colleagues compared the safety of 11,445 simultaneous-bilateral arthroplasties and 26,350 procedures planned for staged-bilateral knee arthroplasties between 1997 and 2007. A total of 23,715 individuals underwent staged-bilateral arthroplasty, after accounting for participants who did not undergo the second procedure because of death, major complication, or elective withdrawal. The major outcomes measured were death, major cardiovascular complications, and a periprosthetic knee infection or mechanical malfunction necessitating revision surgery.

The investigators found that, compared with patients who planned to undergo staged-bilateral arthroplasty, patients who underwent simultaneous-bilateral arthroplasty had significantly higher adjusted odds ratios (ORs) of myocardial infarction and pulmonary embolism (ORs, 1.6 and 1.4, respectively), similar odds of death and ischemic stroke (ORs, 1.3; 95 percent confidence interval [CI], 0.9 to 1.9; and 1.0; 95 percent CI, 0.6 to 1.6, respectively), and significantly lower odds of major joint infection and mechanical malfunction (ORs, 0.6 and 0.7, respectively). Compared with staged-bilateral arthroplasty, after simultaneous-bilateral arthroplasty, the unadjusted 30-day incidence of death or a coronary event was 3.2 events higher per 1,000 patients. After simultaneous-bilateral arthroplasty, the one-year incidence of major joint infection or major mechanical malfunction was 10.5 events lower per 1,000 patients.

"Simultaneous-bilateral total knee arthroplasty was associated with a notable reduction in the incidence of periprosthetic knee infection and mechanical failure," the authors write.

One or more of the study authors disclosed financial ties to an entity in the biomedical arena.

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