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BACKGROUND: Many patients experience bilateral knee osteoarthritis and require bilateral total knee replacement (TKR). Same-stage, bilateral TKR is proposed to be a cost-effective and safe solution compared to two-stage, but conflicting results in the literature are reported. We aim to compare the costs, safety, and rehabilitation performance of patients in same-stage versus two-stage, bilateral TKR with our centre's perioperative protocol. MATERIALS AND METHODS: We retrospectively reviewed 175 patients (95 same-stage, 80 two-stage) who had undergone bilateral TKR in our centre. Patient selection for same-stage, bilateral TKR was strictly protocol-driven and required fulfilment of all criteria, including age < 75 years, American Society of Anesthesiologists (ASA) grade 1 or 2, body mass index (BMI) < 40, and having non-complex arthritis. All patients followed a standardised pre-operative, intra-operative, and post-operative Enhanced Recovery After Surgery (ERAS) protocol. The cost, safety profiles, and rehabilitation outcomes were compared between the same-stage and two-stage groups. RESULTS: The same-stage, bilateral TKR reduced the length of hospital stays by 5.71 days per patient, decreased the operation time by 27.4 min, saved 3.34 (18.6%) physiotherapy sessions, and 3.78 (51.5%) occupational therapy sessions. The same-stage group experienced a higher haemoglobin drop but no significant difference in transfusion percentage, transfusion volume, complication rate, and readmission rate. The two-stage subgroup with anaesthetic risk, age, and BMI similar to the same-stage group showed the same results. Same-stage, bilateral TKR patients experienced no significant difference in final post-operative pain levels and rehabilitation outcomes as two-stage TKR patients. CONCLUSION: This study showed that same-stage, bilateral TKR can reduce costs, with similar safety profiles and rehabilitation outcomes compared to the two-stage, bilateral TKR.
RESUMEN
OBJECTIVES: To introduce the practice of a nurse-led orthopaedic clinic for managing stable patients after total hip or knee replacement and to evaluate its efficacy. DESIGN: Case series. SETTING: A public hospital in Hong Kong. PATIENTS: Patients who had stable primary total knee replacement or total hip replacement done for longer than 2 years were managed in a nurse-led total joint replacement pilot clinic. RESULTS: From July 2012 to March 2014, 431 patients (including 317 with total knee replacement and 114 with total hip replacement) were handled, and 408 (94.7%) nurse assessments were independently performed. Six cases of prosthesis-related complications were diagnosed. One patient was hospitalised for prosthetic complications within 3 months after follow-up. The satisfaction rate was 100%. From November 2012 to April 2013, an advanced practice nurse, one resident specialist, and one associate consultant independently charted Knee Society Knee Score or Harris Hip Score for the patients attending preoperative assessment clinic to check the inter-observer reliability. Overall, 23 patients with 37 knees and 11 patients with 17 hips were examined. The mean correlation coefficient between assessments by the associate consultant and advanced practice nurse was 0.912 for Knee Society Knee Score, and 0.761 for Harris Hip Score. The advanced practice nurse could achieve better or equally good correlation with associate consultant when compared with the correlation between resident specialist and associate consultant (0.866 and 0.521 for Knee Society Knee Score and Harris Hip Score, respectively) and with international standard. CONCLUSION: Nurse-led total joint replacement clinic was safe, reliable, and well accepted by patients.