Optimal timing for bilateral total knee arthroplasty: comparing simultaneous and staged procedures at various intervals: a systematic review and network meta-analysis.

IF 4.3 2区医学 Q1 ORTHOPEDICS

Efort Open Reviews Pub Date : 2025-01-03 Print Date: 2025-01-01 DOI:10.1530/EOR-2024-0070

Cheng-Yang Chang, Kun-Han Lee, Jui-Chien Wang, Shang-Wen Tsai, Cheng-Fong Chen, Po-Kuei Wu, Wei-Ming Chen

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引用次数: 0

Abstract

Purpose: A staged bilateral total knee arthroplasty (BTKA) procedure is considered when a patient is not deemed suitable for simultaneous BTKA due to concerns about the risk of mortality and complications. However, no network meta-analysis has been conducted to compare simultaneous vs staged BTKA procedures with different intervals in terms of postoperative mortality and overall complication rates.

Methods: Four databases - Medline, Embase, Cochrane Library and Web of Science - were searched from inception to December 19, 2023, for studies comparing patients who underwent staged BTKA with different intervals and simultaneous BTKA. The primary outcome domains were 1-year mortality and 90-day overall complications. Secondary outcomes included neurological, cardiovascular, pulmonary, infectious and venous thromboembolic complications within 90 days.

Results: Fifteen observational studies were included. Staged BTKA with intervals between 6 weeks and 3 months (odds ratio (OR): 0.69, 95% CI: 0.53-0.91), between 3 and 6 months (OR: 0.67, 95% CI: 0.53-0.84) and longer than 6 months (OR: 0.67, 95% CI: 0.55-0.83) exhibited a lower mortality risk compared to simultaneous BTKA. Staged BTKA with an interval shorter than 6 weeks and longer than 6 months exhibited a higher risk of pulmonary (OR: 1.24, 95% CI: 1.03-1.49; OR: 1.64, 95% CI: 1.10-2.44) and infectious complications (OR: 1.50, 95% CI: 1.15-1.96; OR: 1.52, 95% CI: 1.14-2.02) compared to simultaneous BTKA. An interval between 3 and 6 months ranked best in outcomes of 1-year mortality (P score = 0.7849) and 90-day complications (P score = 0.7077).

Conclusions: Staged BKTA with an interval of more than 6 weeks but less than 6 months is associated with a lower risk of postoperative mortality and complications. However, these results should be interpreted with caution due to potential biases inherent in the inclusion of nonrandomized studies.

Level of evidence: II.

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目的：当患者因担心死亡率和并发症风险而被认为不适合同时进行双侧全膝关节置换术（BTKA）时，可考虑采用分期手术。然而，就术后死亡率和总体并发症发生率而言，还没有进行过网络荟萃分析来比较不同时间间隔的同期与分期 BTKA 手术：对 Medline、Embase、Cochrane Library 和 Web of Science 这四个数据库进行了检索，以了解从开始到 2023 年 12 月 19 日期间对接受不同时间间隔的分期 BTKA 和同期 BTKA 患者进行比较的研究。主要结果包括 1 年死亡率和 90 天总体并发症。次要结果包括 90 天内的神经、心血管、肺、感染和静脉血栓栓塞并发症：结果：共纳入 15 项观察性研究。与同时进行的 BTKA 相比，间隔时间在 6 周至 3 个月（几率比 (OR)：0.69，95% CI：0.53-0.91）、3 至 6 个月（OR：0.67，95% CI：0.53-0.84）和 6 个月以上（OR：0.67，95% CI：0.55-0.83）的分期 BTKA 死亡率较低。与同时进行的 BTKA 相比，间隔时间短于 6 周和长于 6 个月的分期 BTKA 发生肺部并发症（OR：1.24，95% CI：1.03-1.49；OR：1.64，95% CI：1.10-2.44）和感染性并发症（OR：1.50，95% CI：1.15-1.96；OR：1.52，95% CI：1.14-2.02）的风险更高。在1年死亡率（P值=0.7849）和90天并发症（P值=0.7077）方面，间隔3至6个月的治疗效果最佳：分期 BKTA 间隔时间超过 6 周但少于 6 个月，术后死亡和并发症风险较低。然而，由于纳入非随机研究可能会产生偏差，因此应谨慎解释这些结果：证据等级：II。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Efort Open Reviews Medicine-Orthopedics and Sports Medicine

CiteScore

6.60

自引率

2.90%

发文量

101

审稿时长

13 weeks

期刊介绍： EFORT Open Reviews publishes high-quality instructional review articles across the whole field of orthopaedics and traumatology. Commissioned, peer-reviewed articles from international experts summarize current knowledge and practice in orthopaedics, with the aim of providing systematic coverage of the field. All articles undergo rigorous scientific editing to ensure the highest standards of accuracy and clarity. This continuously published online journal is fully open access and will provide integrated CME. It is an authoritative resource for educating trainees and supports practising orthopaedic surgeons in keeping informed about the latest clinical and scientific advances. One print issue containing a selection of papers from the journal will be published each year to coincide with the EFORT Annual Congress. EFORT Open Reviews is the official journal of the European Federation of National Associations of Orthopaedics and Traumatology (EFORT) and is published in partnership with The British Editorial Society of Bone & Joint Surgery.