1. Is simultaneous bilateral Total Knee Arthroplasty safe in elderly patients above 70 years? A retrospective cohort study of up to 9 years follow up.
Dr. Vipul Vijay, Dr (Prof.) Raju Vaishya
Deptt. of Orthopaedics, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi.
Introduction
Materials & Methods
Continuous increase in number of elderly population in developed countries with fastest growing age > 85 years old.
Population aged >90 years in USA will double from 2 to 4 million from 2010 to 2035.
Likely to be associated with a parallel increase in number of TKA done.
Elderly people unwilling to undergo TKA as compared to younger counterparts.
Advantages of SBTKA as compared to two stage:
Shorter time of exposure to anesthesia,
Less time spent in hospital,
Shorter rehabilitation and physical therapy,
Fewer wound complications,
Decreased surgical stress,
Convenient to family members
More cost-effective treatment
Post operative complications like – UTI, myocardial ischemia, confusion, respiratory tract infection, DVT with positive scan, shifting to high dependency unit or ICU, implant infection, and repeat surgery noted.
Surgery under torniquet
PS cemented knee (Scorpio, Stryker)
Drain used in all cases
Multi-modal DVT prophylaxis used – mechanical & pharmacological
Mobilization as per patient comfort
Data Analysis
Data assimilated by Fellow
Average of all continuous data expressed in mean±SD.
Pre-operative and post –operative KSS assessed by applying Wilcoxon Signed Ranks test. .
Materials & Methods
177 SBTKA between 2003 and 2012.
Retrospective cohort study of 46 patients (92 knees) of age >70 years
Combined spinal epidural anesthesia (93.5%) or general anesthesia (6.5%).
More painful side operated first and 2nd side done during same anesthesia, if no significant events during surgery.
<70 years,
Undergone staged B/L, U/L or uni compartmental knee
arthroplasty,
<Ahlback’s grade IV OA
Revision TKA
All patients had Dobutamine Stress Echo
Associated co-morbidities noted.
Patient’s age, sex, weight, height, BMI, American Society of Anesthesiologist (ASA) grade, Knee Society Score (KSS), tourniquet time, preoperative and postoperative hemoglobin, peri and post operative complications, length of hospital stay, amount of blood in the drain (in first 24 and 48 hours) after surgery, blood transfusions.
Results
Mean/number
Standard deviation/percentage
Age
Sex
Male
Female
BMI
ASA
Grade I
Grade II
Grade III
Grade IV
Grade V
Preoperative Hb
Postoperative Hb
Tourniquet time ( in minutes)
Postoperative blood loss in drain (ml)
80.13 25 21
29.4 12 8 1
12.6
9.94
44.43
45.56
968.19
5.25
54.4%
45.6%
5.36
26.08%
54.34%
17.4%
2.2% 0%
1.62
1.1
14.01
16.63
495.7
Most common post op complication - delirium
Renal dysfunction (2), Angina (2), UTI (2),MI (1).
No hospital mortality or till one year after index surgery
Average time of death after surgery 5.6 years
Exclusion criteria
Discussion
24% patients - no significant co-morbidity.
80% ASA grade 1 or 2.
Significant improvement in post op KSS.
Laskin - in patients >85 years, after TKA 76% could live independently.
Ravi et al – TKA in moderate to severe OA found to be associated with significant (40%) reduction in subsequent risks of serious cardiovascular events.
Materials & Methods
Conclusion
SBTKA not associated with any additional or significant increased risk of morbidity or mortality in this study.
SBTKA seems a safe, effective, and viable procedure for carefully selected elderly patients.