Long Term Outcomes of Single Staged Sequential Bilateral Total Knee Replacement in Patients Aged 60 Years or Above

Article Information

Title: Long Term Outcomes of Single Staged Sequential Bilateral Total Knee Replacement in Patients Aged 60 Years or Above

Authors: Hafeez Ur Rehman, Noman Khan, Shahid Noor, Kazim Rahim Najjad, Nasir Ahmed, Sukaina Rupani, Khalid Khatir

Journal: Journal of the Dow University of Health Sciences (JDUHS)

HEC Recognition History

Category	From	To
Y	2024-10-01	2025-12-31
Y	2023-07-01	2024-09-30
Y	2022-07-01	2023-06-30
Y	2021-07-01	2022-06-30
Y	2020-07-01	2021-06-30

Publisher: DOW University of Health Sciences, Karachi

Country: Pakistan

Year: 2022

Volume: 16

Issue: 2

Language: English

DOI: 10.36570/jduhs.2022.2.1605

Abstract

Objective: To determine the long-term outcomes of single staged bilateral total knee arthroplasty in patients of geriatric age group.Methods: This single-center retrospective study was carried out at Liaquat National Hospital Karachi, Pakistan. Data of 2001 to 2010 were retrieved from the medical records. All geriatric age group patients above 60 years irrespective of comorbidity status, underwent single-stage bilateral total knee arthroplasty were consecutively included. Pre-operative diagnoses such as primary osteoarthritis, post-traumatic arthritis and rheumatoid arthritis were noted. The minimum follow-up time period was 10 years. Long term outcome such as knee society score, adverse event, and need of revision surgery were noted.Results: Of 96 patients, the median age was 69.0 (65.0-76.0) years. There were 44 (45.8%) males and 52 (54.2%) females. Primary osteoarthritis was the most common primary diagnosis, i.e., 66 (68.8%) followed by rheumatoid arthritis in 24 (25.0%), and post-traumatic arthritis in 6 (6.3%) patients. Most of the patients had moderate Charlson Comorbidity Index score, i.e., 70 (72.9%) while Knee Society Score showed that 41 (40%) reported excellent outcome. Need of revision surgery was reported by 6 (6.3%) patients. Adverse events were reported by 11 (11.5%) patients. A significant median difference of Knee Society Score was found among patients with diabetes mellitus (p-value &lt;0.001) and pre-operative diagnosis (p-value &lt;0.001).Conclusion: The long-term outcome of patients underwent bilateral total knee arthroplasty was found satisfactory. It is likely that total knee arthroplasty is widely regarded as the best option for treating end-stage knee osteoarthritis.

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Research Objective

To determine the long-term outcomes of single staged bilateral total knee arthroplasty in patients of geriatric age group (aged 60 years or above).

Methodology

This single-center retrospective study involved retrieving data from medical records at Liaquat National Hospital, Karachi, Pakistan, for the period 2001 to 2010. Patients aged 60 years or above who underwent single-stage bilateral total knee arthroplasty were included, irrespective of comorbidity status. Pre-operative diagnoses, Charlson Comorbidity Index, and Knee Society Scores were recorded. The minimum follow-up period was 10 years. Data analysis included descriptive statistics and inferential statistics using Mann-Whitney and Kruskal-Wallis tests.

Methodology Flowchart

                        graph TD;
    A["Retrieve medical records 2001-2010"] --> B["Identify patients >= 60 years undergoing single-stage bilateral TKA"];
    B --> C["Collect pre-op diagnoses, CCI, KSS, adverse events, revision surgery data"];
    C --> D["Ensure minimum 10-year follow-up"];
    D --> E["Perform descriptive and inferential statistical analysis"];
    E --> F["Analyze long-term outcomes"];

Discussion

The study suggests that single-staged bilateral total knee arthroplasty yields satisfactory long-term outcomes in geriatric patients. While total knee arthroplasty is a well-established treatment for end-stage knee osteoarthritis, the findings contribute to the limited data from Pakistan regarding bilateral procedures. The discussion highlights that while simultaneous bilateral TKA may have more complications, staged procedures offer benefits like reduced hospitalization and cost. The study acknowledges limitations including its retrospective nature and sample size, recommending further prospective multi-center studies.

Key Findings

Of 96 patients, the median age was 69.0 years. Primary osteoarthritis was the most common diagnosis (68.8%). 40% of patients reported an excellent outcome based on the Knee Society Score. Revision surgery was needed by 6.3% of patients, and adverse events were reported by 11.5%. A significant median difference in Knee Society Score was found among patients with diabetes mellitus (p < 0.001) and based on pre-operative diagnosis (p < 0.001).

Conclusion

The long-term outcome of patients who underwent bilateral total knee arthroplasty was found to be satisfactory. Total knee arthroplasty is considered a highly effective option for treating end-stage knee osteoarthritis, significantly reducing pain, restoring function, and improving patient satisfaction.

Fact Check

1. Data Period: Data was retrieved from medical records for the period 2001 to 2010. (Confirmed)
2. Patient Sample Size: A total of 96 patients underwent single-stage bilateral total knee arthroplasty and were included in the study. (Confirmed)
3. Revision Surgery Rate: 6.3% of patients reported the need for revision surgery. (Confirmed)

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