Cost, safety, and rehabilitation of same-stage, bilateral total knee replacements compared to two-stage total knee replacements

Raymond C W Wan; Jason C H Fan; Yuk-Wah Hung; Ka-Bon Kwok; Carmen K M Lo; Kwong-Yin Chung

doi:10.1186/s43019-021-00098-z

Cost, safety, and rehabilitation of same-stage, bilateral total knee replacements compared to two-stage total knee replacements

Knee Surg Relat Res. 2021 Jun 12;33(1):17. doi: 10.1186/s43019-021-00098-z.

Authors

Raymond C W Wan^#¹, Jason C H Fan^#², Yuk-Wah Hung³, Ka-Bon Kwok³, Carmen K M Lo³, Kwong-Yin Chung¹

Affiliations

¹ Department of Orthopedics & Traumatology, Prince of Wales Hospital, Sha Tin, Hong Kong SAR, China.
² Present address: Department of Orthopedics & Traumatology, Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong SAR, China. fchjason@gmail.com.
³ Present address: Department of Orthopedics & Traumatology, Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong SAR, China.

^# Contributed equally.

Abstract

Background: Many patients experience bilateral knee osteoarthritis and require bilateral total knee replacement (TKR). Same-stage, bilateral TKR is proposed to be a cost-effective and safe solution compared to two-stage, but conflicting results in the literature are reported. We aim to compare the costs, safety, and rehabilitation performance of patients in same-stage versus two-stage, bilateral TKR with our centre's perioperative protocol.

Materials and methods: We retrospectively reviewed 175 patients (95 same-stage, 80 two-stage) who had undergone bilateral TKR in our centre. Patient selection for same-stage, bilateral TKR was strictly protocol-driven and required fulfilment of all criteria, including age < 75 years, American Society of Anesthesiologists (ASA) grade 1 or 2, body mass index (BMI) < 40, and having non-complex arthritis. All patients followed a standardised pre-operative, intra-operative, and post-operative Enhanced Recovery After Surgery (ERAS) protocol. The cost, safety profiles, and rehabilitation outcomes were compared between the same-stage and two-stage groups.

Results: The same-stage, bilateral TKR reduced the length of hospital stays by 5.71 days per patient, decreased the operation time by 27.4 min, saved 3.34 (18.6%) physiotherapy sessions, and 3.78 (51.5%) occupational therapy sessions. The same-stage group experienced a higher haemoglobin drop but no significant difference in transfusion percentage, transfusion volume, complication rate, and readmission rate. The two-stage subgroup with anaesthetic risk, age, and BMI similar to the same-stage group showed the same results. Same-stage, bilateral TKR patients experienced no significant difference in final post-operative pain levels and rehabilitation outcomes as two-stage TKR patients.

Conclusion: This study showed that same-stage, bilateral TKR can reduce costs, with similar safety profiles and rehabilitation outcomes compared to the two-stage, bilateral TKR.

Keywords: Cost; Knee osteoarthritis; Rehabilitation outcome; Safety; Total knee replacement.