Chinese Journal of Tissue Engineering Research ›› 2015, Vol. 19 ›› Issue (9): 1321-1328.doi: 10.3969/j.issn.2095-4344.2015.09.002
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Outcomes of one-stage versus two-stage total knee arthroplasty for bilateral knee arthritis
Maddali Taraka Venkata Pavan, Sun Jun-ying, Zha Guo-chun
- Department of Orthopedics, First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
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Revised:2015-01-10Online:2015-02-26Published:2015-02-26 -
Contact:Sun Jun-ying, Professor, Doctoral supervisor, Department of Orthopedics, First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China -
About author:Maddali Taraka Venkata Pavan, Studying for master’s degree, Physician, Department of Orthopedics, First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
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Maddali Taraka Venkata Pavan, Sun Jun-ying, Zha Guo-chun. Outcomes of one-stage versus two-stage total knee arthroplasty for bilateral knee arthritis[J]. Chinese Journal of Tissue Engineering Research, 2015, 19(9): 1321-1328.
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Quantitative analysis and clinical information of subjects All patients were included in the final analysis. No significant difference was detected in patients’ demographics (Table 1). The mean operating time in the one-stage and two-stage groups was 154.7±14.3 minutes versus 171.8±13.4 minutes. We found a significant statistical difference when compared between both groups (P=0.000). No revisions or re-operations were performed. Flow-sheet of the experiments is shown in Figure 1."
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Blood transfusion in patients with bilateral knee arthritis in the one-stage and two-stage groups There was no significant difference between the mean preoperative hemoglobin levels between the two groups (P=0.260). However, the hemoglobin levels were significantly lower postoperatively in the one-stage group compared to that of the two-stage group (P=0.000; Table 2). Sixty patients (88.2%) in the one-stage group, whereas twenty patients (28%) in the two-stage group required transfusion. In the one-stage group, the mean blood transfusion was larger compared to that in two-stage group (P=0.000). There was approximately 14 times increased need for blood transfusion in the one-stage group (Table 2). Length of hospital stay in patients with bilateral knee arthritis in the one-stage and two-stage groups There was a significant difference when comparing the length of hospital stay between the one-stage and two-stage groups (P=0.000). The increased hospital stay in the two-stage group was the result of two individual hospital admissions, therefore increased the total cost. Compared with two-stage TKA, the one-stage TKA cut the length of stay in hospital by almost 50% (Table 2). Hospital charges in patients with bilateral knee arthritis in the one-stage and two-stage groups One-stage TKA is more economical, which enables higher patient satisfaction and a quicker return to function. Total hospital charges averaged RMB 87 428±11 555.9 for one-stage procedure versus RMB 108 937±16 322.6 for two-stage procedure (P=0.000). One-stage procedure was 19.7% less costly compared to two-stage procedure (Table 2)."
Knee recovery in patients with bilateral knee arthritis in the one-stage and two-stage groups The mean postoperative knee score improved significantly in both groups from preoperatively to postoperatively (P= 0.000). The functional score also significantly improved in both groups from 67.8±7.8 versus 66.6±9.6 points preoperatively (P=0.000) to 88.6±9.5 versus 86.3±9.2 points postoperatively (P=0.000) respectively. There was no significant statistical difference detected in the mean postoperative knee score and functional score between both groups at the final follow-up at 5 years (Table 3). Radiographic outcomes in patients with bilateral knee arthritis in the one-stage and two-stage groups In both groups, proper implant alignment was observed at the final follow-up (Figures 2, 3). There were no signs of osteolysis around both the component, or no radiolucent lines at the bone-implant surface. The results are mentioned in Table 4. Patients’ satisfaction in patients with bilateral knee arthritis in the one-stage and two-stage groups Of the 139 patients in both groups, 117 patients (84.1%) were very satisfied with the surgery outcome (P=0.411; Table 3). Adverse reactions and complications in patients with bilateral knee arthritis in the one-stage and two-stage groups No cases of cardiac events, thromboembolism, gastrointestinal bleeding, confusion or stroke were recorded in our study. No deaths were recorded in this study. The present study did not investigate the possibility of deep vein thrombosis, as none of our patients showed or developed significant clinical signs. Five knees developed signs of hematoma; these were small and were resorbed needing no further intervention. Minor wound complication occurred in six patients, which was managed with oral antibiotics and proper wound care (Table 2). We did not find any significant statistical difference in both groups. All the complications that we encountered during our study were minor, which did not need further management."
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