So… you need knee replacement. Should you get them done one at a time or both at once… next
Simultaneous Versus Staged Bilateral Total Knee Arthroplasty
Dr. Jack Cush writing in Rheumnow reported on a metanalysis from 2013 that identified 18 articles which included over 65,000 patients and compared those undergoing single as opposed to simultaneous total knee replacements.
The incidence of mortality was significantly higher in the simultaneous group at 30 days (RR 3.67, 95% CI 1.68–8.02), 3 months (RR 2.45, 95% CI 2.15–2.79) and 1 year (RR 1.85, 95% CI 1.66–2.06) after surgery.
On the other hand there were no significant differences between the two groups with regard to in-hospital mortality R 1.18, 95% CI 0.74–1.88), post-operative deep vein thrombosis, cardiac complications, and pulmonary embolism or infection rates
Thus the higher mortality rate associated with bilateral total knee arthroplasty should impact patient selection for this surgical option. The good news is that there is no differences in other common complications associated with arthroplasty – infection, thrombotic events, etc.
Your orthopedic surgeon wants to do arthroscopic surgery for your meniscus… better watch out!
Arthroscopic surgery for degenerative meniscus tears increases risk for eventual knee replacement
A recent study published in the journal Osteoarthritis Cartilage showed that patients with osteoarthritis of the knee who undergo arthroscopic surgery for degenerative meniscus tears are at markedly increased risk for potentially having total joint replacement. In the study, 335 patients with osteoarthritis of the knee underwent arthroscopic surgery for degenerative meniscus tears. They were followed for two years.
The authors demonstrated that in patients with knee osteoarthritis, arthroscopic knee surgery with meniscectomy is associated with a 3 fold increase in the risk for future knee replacement surgery.
Comment: Don’t do it if you can avoid it. The meniscus serves of function. It helps to cushion the knee. Any meniscus tissue should be preserved.
Here’s something you can do to improve your chances of a good outcome after hip replacement…
Physical therapy before joint replacement surgery reduces need for postoperative care by nearly 30 percent.
News-Medical.Net reported in News-Medical.Net…Physical therapy after total hip (THR) or total knee replacement (TKR) surgery is standard care for all patients. A new study, appearing in the October 1 issue of the Journal of Bone & Joint Surgery (JBJS), also found that physical therapy before joint replacement surgery, or “prehabilitation,” can diminish the need for postoperative care by nearly 30 percent, saving an average of $1,215 per patient in skilled nursing facility, home health agency or other postoperative care.
Comment: This appears to be the standard of care in many places already.
If you’re overweight and need a knee replacement, watch out… next
Obesity linked to longer hospital stays and higher costs.
Obesity is associated with longer hospital stays and higher costs in total knee replacement (TKR) patients, independent of whether or not the patient has an obesity-related disease or condition (comorbidity), according to a new study published in the Journal of Bone and Joint Surgery (JBJS).
More than half of TKR patients have a body mass index within the obesity range (greater than 30 kg/m²), which has been linked to a higher risk for related comorbidities such as diabetes, hypertension, osteoarthritis; and in some studies, to higher medical costs and longer hospital stays.
In a recent study published in the Journal of Bone and Joint Surgery, lead study author Hilal Maradit-Kremers, MD, an associate professor of epidemiology at Mayo Clinic in Rochester, Minn said, “The higher costs associated with obesity are believed to be largely due to managing comorbid medical conditions linked to obesity, such as diabetes.”
• Every 5-unit increase in BMI beyond 30 kg/m² was associated with higher hospitalization costs: in 2010 U.S. dollars, approximately $250 to $300 for patients undergoing TKR and $600 to $650 for patients undergoing a revision joint replacement.
• Every 5-unit increase in BMI beyond 30 kg/m² was associated with a mean hospital stay that was .11 days longer for patients undergoing primary TKR and .06 days longer for patients undergoing revision TKR.
Nancy Walsh writing in MedPage Today reported, “Highly obese patients can derive similar benefits from total knee replacement surgery as other patients,” according to a study presented at the annual meeting of the American Academy of Orthopaedic Surgeons. “During nine years of follow-up, highly obese individuals with a body mass index of at least 35 kg/m2 showed an increase of 50 points on Knee Society knee function scores, compared with an increase of 52 and 56 points for mildly obese and nonobese individuals, respectively,” the study found.
Comment: Not what I would have expected… that’s for sure. Still not a license to chow down at the all you can eat buffet.