Download PDF
J Knee Surg 2024; 37(13): 916-923
DOI: 10.1055/a-2368-4516
Original Article

Comparison of the Cost-Effectiveness and Safety between Staged Bilateral Total Knee Arthroplasty and Simultaneous Bilateral Total Knee Arthroplasty: A Retrospective Cohort Study between 2001 and 2022

Omar W.K. Tsui
1   Department of Orthopaedics and Traumatology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
,
Ping-Keung Chan
1   Department of Orthopaedics and Traumatology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
,
Amy Cheung
2   Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong SAR, China
,
Vincent W.K. Chan 
2   Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong SAR, China
,
Michelle H. Luk 
2   Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong SAR, China
,
Man-Hong Cheung
1   Department of Orthopaedics and Traumatology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
,
Lawrence C.M. Lau
1   Department of Orthopaedics and Traumatology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
,
Thomas K.C. Leung
2   Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong SAR, China
,
Henry Fu
1   Department of Orthopaedics and Traumatology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
,
Kwong-Yuen Chiu
1   Department of Orthopaedics and Traumatology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
› Author Affiliations Funding None.
› Further Information
    Permissions and Reprints

Abstract

A substantial proportion of Hong Kong's aging population suffers from osteoarthritis in both knees. Bilateral total knee arthroplasty (BTKA) is a surgical option for addressing this condition and can be performed via two approaches: simultaneous BTKA (SimBTKA) and staged BTKA (StaBTKA). We compared the cost-effectiveness and safety of these two methods in our institution. We retrospectively reviewed 2,372 patients (SimBTKA, 772; StaBTKA, 1,600; females, 1,780; males, 592; mean age at SimBTKA, 70.4 ± 7.99 years; mean age at StaBTKA, 66.4 ± 7.50 years; p < 0.001) who underwent BTKA in our institution from 2001 to 2022. Patients were categorized according to the surgical approach. Patients undergoing BTKA in our institution were included. Particularly for SimBTKA, patients were assessed by anesthetists to be medically fit before undergoing the procedure according to their age, American Society of Anesthesiologists status, and osteoarthritis severity. The primary outcome was the length of stay (LOS) after surgery. The secondary outcomes were the 30-day unintended readmission, intensive care unit (ICU) admission, and death. SimBTKA had a shorter mean total LOS (acute hospital + rehabilitation center; SimBTKA, 13.09 days; StaBTKA, 18.12 days; p < 0.001) and mean LOS in acute hospital (SimBTKA, 7.70 days; StaBTKA, 10.42 days; p < 0.001). However, no significant difference was found in the mean LOS in rehabilitation centers (SimBTKA, 5.47 days; StaBTKA, 6.32 days; p > 0.05) between the two approaches. The 30-day unintended readmission rate was lower in SimBTKA (SimBTKA, 2.07%; StaBTKA, 3.30%; odds ratio [OR] = 1.60; p > 0.05) but statistically insignificant. SimBTKA was less costly than StaBTKA by US$ 8,422.22 per patient. No significant differences in ICU admission and death rates were found (p > 0.05) between the two groups. SimBTKA had a shorter LOS and lower cost than StaBTKA and comparable complication rates. Therefore, SimBTKA should be indicated in medically stable patients.

Keywords

total knee arthroplasty - cost-effectiveness - aging - pain - anesthesia

Consent for Publication

Patient consent was waived due to the retrospective nature of the study.


Availability of Data and Materials

Publicly available data included in the article are listed in the “References” section. The data used in this research article are available upon request from the corresponding author, in accordance with ethical and privacy considerations.


Supplementary Material



Publication History

Received: 27 February 2024

Accepted: 16 July 2024

Accepted Manuscript online:
17 July 2024

Article published online:
02 September 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Kanasi E, Ayilavarapu S, Jones J. The aging population: demographics and the biology of aging. Periodontol 2000 2016; 72 (01) 13-18
    CrossrefPubMedGoogle Scholar
  • 2 Hussain N, Chien T, Hussain F. et al. Simultaneous versus staged bilateral total knee arthroplasty: a meta-analysis evaluating mortality, peri-operative complications and infection rates. HSS J 2013; 9 (01) 50-59
    CrossrefPubMedGoogle Scholar
  • 3 Makaram NS, Roberts SB, Macpherson GJ. Simultaneous bilateral total knee arthroplasty is associated with shorter length of stay but increased mortality compared with staged bilateral total knee arthroplasty: a systematic review and meta-analysis. J Arthroplasty 2021; 36 (06) 2227-2238
    CrossrefPubMedGoogle Scholar
  • 4 Yakkanti RR, Ovadia JE, Reddy GB, Browne JA, D'Apuzzo MR. Inhospital complications and costs of simultaneous bilateral total knee arthroplasty: the case for selection and potential cost savings. J Arthroplasty 2022; 37 (07) 1273-1277
    CrossrefPubMedGoogle Scholar
  • 5 March LM, Cross M, Tribe KL. et al; Arthritis C.O.S.T. Study Project Group. 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 (05) 400-408
    PubMedGoogle Scholar
  • 6 Bohm ER, Molodianovitsh K, Dragan A. et al. Outcomes of unilateral and bilateral total knee arthroplasty in 238,373 patients. Acta Orthop 2016; 87 (Suppl. 01) 24-30
    CrossrefPubMedGoogle Scholar
  • 7 Wilkie W, Mohamed N, Remily E, Pastore M, Nace J, Delanois RE. Same day versus staged total knee arthroplasty: do cost savings justify the risk?. J Knee Surg 2022; 35 (03) 288-293
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Phillips JLH, Rondon AJ, Gorica Z, Fillingham YA, Austin MS, Courtney PM. No difference in total episode-of-care cost between staged and simultaneous bilateral total joint arthroplasty. J Arthroplasty 2018; 33 (12) 3607-3611
    CrossrefPubMedGoogle Scholar
  • 9 Sarzaeem MM, Amoozadeh Omrani F, Omidian MM, Sahebalzamani MA, Maniei E. Clinical outcome comparison between staged -Bilateral versus simultaneous bilateral total knee replacements. Arch Bone Joint Surg 2021; 9 (06) 641-646
    PubMedGoogle Scholar
  • 10 Chou TA, Ma HH, Tsai CW. et al. The safety and cost-analysis of simultaneous versus staged bilateral total knee arthroplasty in a Taiwan population. J Chin Med Assoc 2023; 86 (05) 494-498
    CrossrefPubMedGoogle Scholar
  • 11 Hou JF, Hu C, Zhang Y. et al. Cost analysis of staged versus simultaneous bilateral total knee and hip arthroplasty using a propensity score matching. BMJ Open 2021; 11 (03) e041147
    CrossrefPubMedGoogle Scholar
  • 12 Bang H, Zhao H. Cost-effectiveness analysis: a proposal of new reporting standards in statistical analysis. J Biopharm Stat 2014; 24 (02) 443-460
    CrossrefPubMedGoogle Scholar
  • 13 Odum SM, Troyer JL, Kelly MP, Dedini RD, Bozic KJ. A cost-utility analysis comparing the cost-effectiveness of simultaneous and staged bilateral total knee arthroplasty. J Bone Joint Surg Am 2013; 95 (16) 1441-1449
    CrossrefPubMedGoogle Scholar
  • 14 Goh GS, Sutton RM, D'Amore T, Baker CM, Clark SC, Courtney PM. A time-driven activity-based costing analysis of simultaneous versus staged bilateral total hip arthroplasty and total knee arthroplasty. J Arthroplasty 2022; 37 (8S): S742-S747
    CrossrefPubMedGoogle Scholar
  • 15 Sing CW, Woo YC, Lee ACH. et al. Validity of major osteoporotic fracture diagnosis codes in the Clinical Data Analysis and Reporting System in Hong Kong. Pharmacoepidemiol Drug Saf 2017; 26 (08) 973-976
    CrossrefPubMedGoogle Scholar
  • 16 Choi YJ, Lee HI, Ra HJ, Hwang DY, Kim TK, Shim SJ. Perioperative risk assessment in patients aged 75 years or older: comparison between bilateral and unilateral total knee arthroplasty. Knee Surg Relat Res 2014; 26 (04) 222-229
    CrossrefPubMedGoogle Scholar
  • 17 Noble J, Goodall JR, Noble DJ. Simultaneous bilateral total knee replacement: a persistent controversy. Knee 2009; 16 (06) 420-426
    CrossrefPubMedGoogle Scholar
  • 18 Lane GJ, Hozack WJ, Shah S. et al. Simultaneous bilateral versus unilateral total knee arthroplasty. Outcomes analysis. Clin Orthop Relat Res 1997; 345 (345) 106-112
    PubMedGoogle Scholar
  • 19 Hong Kong Hospital Authority. Hospital Authority Ordinance. Hong Kong Hospital Authority. Accessed August 9, 2023 at: https://www.ha.org.hk/visitor/ha_visitor_index.asp?Content_ID=10045&Lang=ENG
    PubMed
  • 20 Gasparini A. Comorbidity: an R package for computing comorbidity scores. J Open Source Softw 2018; 3 (23) 648
    CrossrefPubMedGoogle Scholar
  • 21 Gleneagles Hospital. GHK all-inclusive package price list. Hong Kong, China: Gleneagles Hospital. Accessed July 19, 2024 at: https://gleneagles.hk/media/GHK-All-Inclusive-Package-Price-List-ORT04.pdf
    PubMed
  • 22 Wan RCW, Fan JCH, Hung YW, Kwok KB, Lo CKM, Chung KY. Cost, safety, and rehabilitation of same-stage, bilateral total knee replacements compared to two-stage total knee replacements. Knee Surg Relat Res 2021; 33 (01) 17
    CrossrefPubMedGoogle Scholar
  • 23 Cheung A, Chan PK, Fu H. et al. Total knee arthroplasty is safe for patients aged ≥80 years in Hong Kong. Hong Kong Med J 2021; 27 (05) 350-354
    CrossrefPubMedGoogle Scholar
  • 24 Sloan M, Premkumar A, Sheth NP. Projected volume of primary total joint arthroplasty in the U.S., 2014 to 2030. J Bone Joint Surg Am 2018; 100 (17) 1455-1460
    CrossrefPubMedGoogle Scholar
  • 25 Richardson MK, Liu KC, Mayfield CK, Kistler NM, Christ AB, Heckmann ND. Complications and safety of simultaneous bilateral total knee arthroplasty: a patient characteristic and comorbidity-matched analysis. J Bone Joint Surg Am 2023; 105 (14) 1072-1079
    CrossrefPubMedGoogle Scholar
  • 26 Abdelaal MS, Calem D, Sherman MB, Sharkey PF. Short interval staged bilateral total knee arthroplasty: safety compared to simultaneous and later staged bilateral total knee arthroplasty. J Arthroplasty 2021; 36 (12) 3901-3908
    CrossrefPubMedGoogle Scholar
  • 27 Harris AB, Wang KY, Mo K, Gu A, Rao SS, Thakkar SC. Outpatient simultaneous bilateral total knee arthroplasty: is it safe?. J Arthroplasty 2022; 37 (04) 699-703
    CrossrefPubMedGoogle Scholar
  • 28 Franceschetti E, Campi S, Gregori P. et al. No differences in terms of complications, readmissions, reoperations, and patient-reported outcomes in simultaneous bilateral versus staged bilateral total knee arthroplasty in selected patients. Knee 2024; 47: 151-159
    CrossrefPubMedGoogle Scholar
  • 29 Gali JC, Brotto AFC, de Mello DPP, Mauad JR, Gali Filho JC. Simultaneous bilateral total knee arthroplasty may be safe. Rev Bras Ortop 2022; 58 (03) 428-434
    PubMedGoogle Scholar
  • 30 Klasan A, Putnis SE, Yeo WW. et al. Should sequential bilateral total knee arthroplasty be limited to patients younger than 80? A two-arm propensity matched study. J Knee Surg 2021; 34 (14) 1579-1586
    Article in Thieme ConnectPubMedGoogle Scholar
  • 31 Putnis SE, Klasan A, Redgment JD, Daniel MS, Parker DA, Coolican MRJ. One-stage sequential bilateral total knee arthroplasty: an effective treatment for advanced bilateral knee osteoarthritis providing high patient satisfaction. J Arthroplasty 2020; 35 (02) 401-406
    CrossrefPubMedGoogle Scholar