Simultaneous vs staged bilateral total knee arthroplasty among Medicare beneficiaries, 2000-2009.
Simultaneous bilateral total knee arthroplasty (TKA) reportedly has higher postoperative complication rates than staged procedures, but little is known about recent trends and outcomes among Medicare patients. In a 5% national sample of Medicare beneficiaries older than 65 years, we identified 83,441 patients who underwent elective TKA between 2000 and 2009 and compared patients undergoing simultaneous bilateral TKA (n=4519) to staged TKA (n=3788). Use of simultaneous TKA did not change over time (3 in 10,000), but use of staged TKA increased three-fold from 1.4 to 4.4 in 10,000 person-years. We assessed length of stay; 5-year risk of revision; periprocedural (i.e., 90-day) risk of infection; hospitalization for venous thromboembolism (VTE) and myocardial infarction (MI); and death using Kaplan-Meier methods. Simultaneous TKA had higher 90-day risk of death (0.7% vs. 0.3%, P=0.02), VTE (0.9% vs. 0.5%, P=0.07), and MI (0.5% vs. 0.2%, P=0.02). Infection and revision rates were similar between the two groups.
Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina.
Michael P
MP
Bolognesi
Tyler Steven
TS
Watters
David E
DE
Attarian
Samuel S
SS
Wellman
Soko
S
Setoguchi
D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000379:methods* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D007720:Knee Prosthesis / Q000382:microbiology; D007902:Length of Stay; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D020370:Osteoarthritis, Knee / Q000453:epidemiology* / Q000601:surgery*; D016459:Prosthesis-Related Infections / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D020246:Venous Thrombosis / Q000453:epidemiology
Medicare; simultaneous bilateral total knee arthroplasty; staged bilateral total knee arthroplasty