Retrospective Cohort Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jan 18, 2022; 13(1): 58-69
Published online Jan 18, 2022. doi: 10.5312/wjo.v13.i1.58
Should we use similar perioperative protocols in patients undergoing unilateral and bilateral one-stage total knee arthroplasty?
Artit Laoruengthana, Piti Rattanaprichavej, Parin Samapath, Bhuwad Chinwatanawongwan, Pariphat Chompoonutprapa, Krit Pongpirul
Artit Laoruengthana, Piti Rattanaprichavej, Parin Samapath, Bhuwad Chinwatanawongwan, Pariphat Chompoonutprapa, Department of Orthopaedics, Naresuan University, Mueang 65000, Phitsanulok, Thailand
Krit Pongpirul, Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
Author contributions: Laoruengthana A contributed to the conception and design of the study, and performed the operation as the surgeon; Rattanaprichavej P, Samapath P, Chinwatanawongwan B, and Chompoonutprapa P collected the required data; Laoruengthana A and Rattanaprichavej P wrote and completed the manuscript; Laoruengthana A, Rattanaprichavej P, and Pongpirul K were responsible for data interpretation and performed the statistical analysis; all authors have read and approved the manuscript.
Institutional review board statement: The study was reviewed and approved by the Naresuan University Institutional Review Board (No. 756/2017).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no competing interests related to the study design, data collection, and interpretation of results presented in this manuscript.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
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:
Corresponding author: Piti Rattanaprichavej, MD, Associate Professor, Director, Lecturer, Surgeon, Department of Orthopaedics, Naresuan University, 99 Moo 9, Mueang 65000, Phitsanulok, Thailand.
Received: April 28, 2021
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
Research background

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.

Research motivation

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.

Research objectives

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.

Research methods

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.

Research results

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.

Research conclusions

Patients who undergo BTKA may require more extensive perioperative care for blood loss and pain than those patients who undergo UTKA.

Research perspectives

Future prospective studies may be required to develop a particular perioperative protocol in patients undergoing BTKA to decrease potential morbidity and mortality.