Tek seansta iki taraflı ile tek taraflı total diz artroplastisinin karşılaştırılması

Öz

Amaç: Bu çalışmada tek seansta iki taraflı total diz artroplastisi (İTDA) ve tek taraflı total diz artroplastisinin (TTDA) morbidite, klinik ve radyolojik bulgular ile hayat kalitesi yönünden karşılaştırılması amaçlandı.

Çalışma planı: Kasım 2007 - Haziran 2012 tarihleri arasında tek seansta gerçekleştirilen 48 İTDA (46 kadın, 2 erkek; ortalama yaş: 64.00±8.31) ile 53 TTDA (45 kadın, 8 erkek; ortalama yaş: 64.40±7.45) hastası çalışmaya dahil edildi. Gruplar, komorbidite, komplikasyon, kan transfüzyonu, hastanede kalış süreleri, klinik ve radyolojik (AKSS) bulgular ve hayat kalitesi (SF-36) yönünden değerlendirildi.

Bulgular: İkisi cerrahi sonrası ilk 30 gün içinde olmak üzere, İTDA grubundan 3 hastada, TTDA grubundan 1 hastada pulmoner emboli gelişmesi nedeniyle hastaların yoğun bakım servisinde takibi yapıldı. İTDA grubundan 1 hasta erken dönemde; yine İTDA grubundan 1 hasta ile TTDA grubundan 1 hasta da bir yıl içinde yaşamlarını yitirdi. Hastaların hastanede kaldığı süreler, cerrahi sırasındaki kan transfüzyon miktarları ve mortalite bulguları TTDA lehine, revizyon bulguları İTDA lehine istatistiksel olarak anlamlı bulundu (p<0.05). Diz ve fonksiyon puanları ile SF-36’nın sekiz parametresinde tüm hastalarda artış görülürken, iki grup arasında anlamlı bir fark bulunmadı (p>0.05).

Çıkarımlar: Yetmiş yaş altında, ek hastalığı olmayan, uyumlu hasta seçimi ile tek seansta İTDA’nın uygulanması bir seçenek olarak düşünülebilir.

Anahtar Kelimeler

• Komplikasyon; tek seansta iki taraflı; tek taraflı; total diz artroplastisi.

Comparison of simultaneous bilateral with unilateral total knee arthroplasty

Abstract

Objective: The aim of this study was to compare simultaneous bilateral total knee arthroplasty (BTKA) and unilateral total knee arthroplasty (UTKA) in terms of morbidity, clinical and radiological findings and quality of life.

Methods: The study included 48 simultaneous BTKAs (46 females, 2 males; mean age: 64.00±8.31 years) and 53 UTKAs (46 females, 7 males; mean age: 64.40±7.45 years) performed between November 2007 and June 2012. Groups were compared with respect to comorbidity, complications, blood transfusion, hospital stay, clinical and radiological (American Knee Society Score) findings and quality of life (SF-36).

Results: Three patients in the BTKA group and 1 in the UTKA group required intensive care admission due to pulmonary embolism; 2 cases occurred within the first postoperative 30 days. One BTKA patient died in the early postoperative period and 1 patient from the BTKA and 1 from the UTKA group died within 1 year. Hospital stay, perioperative blood transfusion parameters and mortality rates were significantly different in favor of UTKA and revision operation rates in favor of BTKA (p<0.05). All patients had improved knee and function scores and SF-36 scores. However, there was no significant difference between the groups (p>0.05).

Conclusion: Simultaneous BTKA should be considered in selected patients under 70 years of age with good compliance and no comorbid disease.

Keywords

• Complication
• simultaneous bilateral
• total knee arthroplasty
• unilateral

Kaynakça

1. Thadani PJ, Spitzer AI. Primary total knee arthroplasty: Indications and long-term results. Curr Opin Orthop 2000;11:41-8. CrossRef
2. Aydogdu S, Sur H. Total knee prostheses. In: Ege R, editor. Knee problems. Ankara: Bizim Büro Basımevi; 1998. p. 391-403.
3. Macario A, Schilling P, Rubio R, Goodman S. Economics of one-stage versus two-stage bilateral total knee arthroplasties. Clin Orthop Relat Res 2003;414:149-56. CrossRef
4. March LM, Cross M, Tribe KL, Lapsley HM, Courtenay BG, Cross MJ, et al. Two knees or not two knees? Patient costs and outcomes following bilateral and unilateral total knee joint replacement surgery for OA. Osteoarthritis Cartilage 2004;12:400-8. CrossRef
5. Noble J, Goodall JR, Noble DJ. Simultaneous bilateral total knee replacement: a persistent controversy. Knee 2009;16:420-6. CrossRef
6. Bullock DP, Sporer SM, Shirreffs TG Jr. Comparison of simultaneous bilateral with unilateral total knee arthroplasty in terms of perioperative complications. J Bone Joint Surg Am 2003;85-A:1981-6.
7. Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 1989;248:13-4.
8. Insall JN, Easley ME. Surgical techniques and instrumentation in total knee arthroplasty. In: Insall JN, Scott WN, editors. Insall & Scott Surgery of the knee. 3rd ed. New York, NY: Churchill Livingstone; 2001. p. 1553-620.

9. Ware JE Jr. SF-36 health survey update. Spine 2000;25:3130-9. CrossRef
10. Goldberg VM, Kraay M. The outcome of the cementless tibial component: a minimum 14-year clinical evaluation. Clin Orthop Relat Res 2004;428:214-20. CrossRef
11. Bassett RW. Results of 1,000 Performance knees: cementless versus cemented fixation. J Arthroplasty 1998;13:409 CrossRef
12. Gill GS, Joshi AB. Long-term results of Kinematic Condylar knee replacement. An analysis of 404 knees. J Bone Joint Surg Br 2001;83:355-8. CrossRef
13. Akgün I, Oğüt T, Kesmezacar H, Yücel I. Total knee arthroplasty: a 4.5-year follow-up. Acta Orthop Traumatol Turc 2002;36:93-9.
14. Barrack RL, Bertot AJ, Wolfe MW, Waldman DA, Milicic M, Myers L. Patellar resurfacing in total knee arthroplasty. A prospective, randomized, double-blind study with five to seven years of follow-up. J Bone Joint Surg Am 2001;83-A:1376-81.
15. Heal J, Blewitt N. Kinemax total knee arthroplasty: trial by template. J Arthroplasty 2002;17:90-4. CrossRef
16. Waters TS, Bentley G. Patellar resurfacing in total knee arthroplasty. A prospective, randomized study. J Bone Joint Surg Am 2003;85-A:212-7.
17. Barrett J, Baron JA, Losina E, Wright J, Mahomed NN, Katz JN. Bilateral total knee replacement: staging and pulmonary embolism. J Bone Joint Surg Am 2006;88:2146 CrossRef
18. Oakes DA, Hanssen AD. Bilateral total knee replacement using the same anesthetic is not justified by assessment of the risks. Clin Orthop Relat Res 2004;428:87-91. CrossRef
19. Jankiewicz JJ, Sculco TP, Ranawat CS, Behr C, Tarrentino S. One-stage versus 2-stage bilateral total knee arthroplasty. Clin Orthop Relat Res 1994;309:94-101.
20. Hersekli MA, Akpinar S, Ozalay M, Ozkoç G, Uysal M, Cesur N, et al. A comparison between single- and twostaged bilateral total knee arthroplasty operations in terms of the amount of blood loss and transfusion, perioperative complications, hospital stay, and cost-effectiveness. [Article in Turkish] Acta Orthop Traumatol Turc 2004;38:241-6. Lane GJ, Hozack WJ, Shah S, Rothman RH, Booth RE Jr, Eng K, et al. Simultaneous bilateral versus unilateral total knee arthroplasty. Outcomes analysis. Clin Orthop Relat Res 1997;345:106-12. CrossRef
21. Fabi DW, Mohan V, Goldstein WM, Dunn JH, Murphy BP. Unilateral vs bilateral total knee arthroplasty risk factors increasing morbidity. J Arthroplasty 2011;26:668-73. Hungerford DS, Krackow KA, Kenna RV. Cementless total knee replacement in patients 50 years old and under. Orthop Clin North Am 1989;20:131-45.
22. Ritter MA, Harty LD, Davis KE, Meding JB, Berend M. Simultaneous bilateral, staged bilateral, and unilateral total knee arthroplasty. A survival analysis. J Bone Joint Surg Am 2003;85-A:1532-7.
23. Kilincoglu V, Unay K, Akan K, Esenkaya I, Poyanli O. Component alignment in simultaneous bilateral or unilateral total knee arthroplasty. Int Orthop 2011;35:43-6. CrossRef Parvizi J, Sullivan TA, Trousdale RT, Lewallen DG. Thirty-day mortality after total knee arthroplasty. J Bone Joint Surg Am 2001;83-A:1157-61.
24. Hersekli MA, Akpınar S, Özkoç G, Özalay M, Cesur N, Uysal M, et al. Single-staged bilateral total knee arthroplasty: the role of elderly age (70+ years) on perioperative complications. Joint Dis Rel Surg 2005;16:1-4.
25. Gill GS, Mills D, Joshi AB. Mortality following primary total knee arthroplasty. J Bone Joint Surg Am 2003;85A:432Kim YH, Choi YW, Kim JS. Simultaneous bilateral sequential total knee replacement is as safe as unilateral total knee replacement. J Bone Joint Surg Br 2009;91:64-8. CrossRef
26. Mangaleshkar SR, Prasad PS, Chugh S, Thomas AP. Staged bilateral total knee replacement-a safer approach in older patients. Knee 2001;8:207-11. CrossRef
27. Brassard MF, Insall JN, Scuderi GR. Complications of total knee arthroplasty. In: Insall JN, editor. Surgery of the knee. 3rd ed. New York, NY: Churchill Livingstone; 2001. p. 1801-44.
28. Pavone V, Johnson T, Saulog PS, Sculco TP, Bottner F. Perioperative morbidity in bilateral one-stage total knee replacements. Clin Orthop Relat Res 2004;421:155-61.
29. Soudry M, Binazzi R, Insall JN, Nordstrom TJ, Pellicci PM, Goulet JA. Successive bilateral total knee replacement. J Bone Joint Surg Am 1985;67:573-6.
30. Robertsson O, Knutson K, Lewold S, Lidgren L. The Swedish Knee Arthroplasty Register 1975-1997: an update with special emphasis on 41,223 knees operated on in 1988-1997. Acta Orthop Scand 2001;72:503-13. CrossRef
31. Hutchinson JR, Parish EN, Cross MJ. A comparison of bilateral uncemented total knee arthroplasty: simultaneous or staged? J Bone Joint Surg Br 2006;88:40-3. CrossRef
32. Sulek CA, Davies LK, Enneking FK, Gearen PA, Lobato EB. Cerebral microembolism diagnosed by transcranial Doppler during total knee arthroplasty: correlation with transesophageal echocardiography. Anesthesiology 1999;91:672-6. CrossRef
33. Salaffi F, Carotti M, Grassi W. Health-related quality of life in patients with hip or knee osteoarthritis: comparison of generic and disease-specific instruments. Clin Rheumatol 2005;24:29-37. CrossRef