Transcript Document
Simultaneous Bilateral vs Unilateral TKR Complications & Analysis of the Patient’s Perspective Chloe Donovan RN David A Parker FRACS
SORI Sydney Australia www.sori.com.au
AOA Annual Scientific Meeting Adelaide, 2010
Conflict of Interest
There is no conflict of interest in this research project Sydneyortho.com.au/sori_page
Bilateral Knee OA
Common presentation Simultaneous vs Staged Considerations Risks / Complications Rehabilitation Comorbidities Patient’s desires / concerns “ Will I have a leg to stand on afterwards?” Sydneyortho.com.au/sori_page
Bilateral TKR: Literature
Several studies Variable results Increased morbidity • Patil et al 2008, Fabi et al 2010, Qian et al 2008 Increased mortality • Mangaleshkar 2001, Stafansdottir 2008 No increased risk • Taylor et al 2010, Leonard et al 2003 Sydneyortho.com.au/sori_page
Bilateral TKR: Literature
Limitations Heterogeneous groups Many fail to compare to 2 x Unilateral Lack of attention to other aspects of patient outcomes • Leonard et al 2003: Increased patient satisfaction with Bilateral procedures Sydneyortho.com.au/sori_page
Study Aims
Comparison of: Unilateral Staged Bilateral Simultaneous Bilateral Analysis of: Complications Outcomes Patient Satisfaction & Perspective Sydneyortho.com.au/sori_page
Indications for Simultaneous BTKR
Each Knee independently meets appropriate criteria for TKR Medically fit (Physician review) Patient elects surgery Especially significant fixed deformities Sydneyortho.com.au/sori_page
Simultaneous Bilateral TKR
Commence with most symptomatic 1 st completed, tourniquet deflated, extensor mechanism closed, before 2 nd started Computer Navigation routine Sydneyortho.com.au/sori_page
Methods
Single Surgeon Consecutive Series 205 patients / 329 TKR Dec 2004 to June 2009 Minimum 1 yr followup 3 Groups • • 89 Simultaneous BTKR (2.1years) 81 Unilateral TKR (3.2 years) • 35 Staged Bilateral TKR (4 year) Sydneyortho.com.au/sori_page
Methods: Data Collection
Ethics approval via NSHHREC Ethics committee Retrospective Review Prospective Database (Socrates) • Oxford, KSCRS, WOMAC, SF-36 Hospital Records Patient Satisfaction Questionnaire Self - administered Sydneyortho.com.au/sori_page
Methods: Patient Questionnaire
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Results: Patient Demographics
* 90 80 70 60 50 40 30 20 10 0 n=81 Unilateral
Age
n=35 Staged n=89 Simultaneous 25 20 15 50 45 40 35 30 * Significantly different to Simultaneous group (p<0.05) n=51 Unilateral
BMI
n=31 Staged n=62 Simultaneous Sydneyortho.com.au/sori_page
Results: Complication Rate (%)
Retention Postop delirium VTE Blood Tx ICU Other
Unilateral Staged Simultaneous P-value
3.3
6.9
5.7
0.59
11.7
8.3
10.7
3.4
5.7
4.6
0.23
0.66
10.0
3.3
3.3
3.4
0.0
3.4
10.3
6.9
2.3
0.45
0.47
0.74
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Oxford
50 45 40 35 30 25 20 15 10 5 0 Unilateral Pre-Op Post-Op Staged Simultaneous Sydneyortho.com.au/sori_page
WOMAC
30 20 10 0 70 60 50 40 Unilateral Pre-Op Post-Op Staged Simultaneous Sydneyortho.com.au/sori_page
Range of Motion
60 40 20 0 140 120 100 80 Unilateral Staged Pre-Op Post-Op Simultaneous Sydneyortho.com.au/sori_page
Results: SF36 – Physical Score
60 * * * † 50 40 30 Pre-op Post-op 20 10 n=67 n=50 0 Unilateral * Significantly different to pre-op (p<0.05) n=33 n=27 n=68 n=53 Staged Simultaneous † Significantly different to Staged (p<0.05) Sydneyortho.com.au/sori_page
Results: SF36 – Mental Score
70 60 50 40 30 20 10 n=67 n=50 0 Unilateral * Significantly different to Staged (p<0.05) n=33 n=27 Staged * n=68 n=53 Simultaneous Pre-op Post-op Sydneyortho.com.au/sori_page
Results: Patient Satisfaction
2 0 6 4 12 10 8 * Unilateral Staged * Significantly different to Unilateral and Staged (p<0.05) Simultaneous Sydneyortho.com.au/sori_page
Discussion
Bilateral Simultaneous TKR Controversial • Increased morbidity / mortality • Inconsistencies in literature Minimal investigation into patients’ perspective Potential benefits for the patient • Rehabilitation & Clinical Outcome • Efficiency / Costs / Expedience Sydneyortho.com.au/sori_page
Discussion
Current investigation No increase in morbidity / mortality Equivalent or better functional outcomes Improved patient satisfaction Negative preconceptions proved incorrect Effect of better preop SF36 mental scores Limitations Differences in groups (not RCT) Questionnaire not validated Sydneyortho.com.au/sori_page
Conclusion
Bilateral Simultaneous TKR Bilateral advanced OA • Especially significant fixed deformities Healthy patients (Physician approval) Patient request Further study Increasing database Development & Validation of questionnaire Sydneyortho.com.au/sori_page
Thankyou
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