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• W3019600400 abstract "Purpose: A third of knee Osteoarthritis present with bilateral symptomatic arthritis. In these patients, treatment options include either a staged Unilateral Total knee arthroplasty (UTKA) procedure, often with a few months in between surgeries, or a simultaneous Bilateral TKA (BTKA) procedure. Even though the literature regarding the outcomes in BTKA procedure has not consistently been favorable, it remains popular in select patients due to the use of a single anesthetic, a shorter overall surgical time, lower cost and lower overall use of narcotics. African Americans (AAs) have lower utilization and worse outcomes in UTKA literature. However, it is unclear whether these racial variations extend to BTKA. Therefore, in a large national sample, we sought to examine BTKA vs UTKA utilization rates and outcomes comparing AA and white patients. Methods: We used the National Inpatient Sample (NIS) - Healthcare Cost and Utilization Project (HCUP) database from 2007 through 2016. We identified all patients ≥50 years who underwent elective primary TKA using the ICD-9-CM procedure code 81.54 for TKA and BTKA from January 1, 2012 through September 30, 2015, and ICD-10 procedure codes 0SRC0x and 0SRD0x thereafter. Patients with inflammatory arthritis, pathologic fractures, metastatic disease and avascular necrosis were excluded. Major in-hospital complications included - post-operative myocardial infarction, prosthetic device complication, surgical wound infection, and venous thromboembolism. Differences in temporal trends in utilization and major in-hospital complications of BTKA vs UTKA were compared between AAs and Whites. Multivariable logistic regression models were used to assess the differences in both these trends between AAs and Whites after adjusting for individual (age, sex, Elixhauser comorbidity index, and morbid obesity), hospital level (hospital volume, bed size, region and teaching status) and community level (median household income) variables. Discharge weights were used to enable nationwide estimates. Results: From 2007 through 2016, an estimated 276,194 BTKA (unweighted observations 56,675) and 5,528,429 UTKA (unweighted observations 1,131,329) were identified (Table 1). Females had a higher proportion of TKAs performed (62.1% UTKA vs 55.9% BTKA). Patients had fewer comorbidities (measured by the Elixhauser Index) when undergoing BTKA compared to UTKA. The proportion of BTKA amongst all TKAs declined from 5.53% in 2007-08 to 4.03% in 2015-16. African Americans continued to have lower proportion of BTKA utilization as compared to Whites (4.68% in AAs vs 6.08% in Whites in 2007-08, whereas 3.28% in AAs vs 4.19% in Whites in 2015-16). The adjusted difference in trends was significant between AAs and Whites (p < 0.001) (Figure 1a). For in-hospital complications post TKA, our results showed that the complication rates for UTKA and BTKA differ significantly by race. Bilateral complication rates were significantly different from unilateral complication rates among AAs (p < 0.05) whereas the difference between UTKA and BTKA complication rates among Whites are not significant (Figure 1b). Conclusions: In this nationwide sample of patients who underwent TKA surgery between 2007 and 2016, we found that AAs patients to have lower utilization rate of BKTA compared to White. We also found that the in-hospital complication rates differ significant by Race and TKA surgical type.View Large Image Figure ViewerDownload Hi-res image Download (PPT)View Large Image Figure ViewerDownload Hi-res image Download (PPT)" @default.
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• W3019600400 date "2020-04-01" @default.
• W3019600400 modified "2023-09-28" @default.
• W3019600400 title "Variations in the utilization of bilateral total knee arthroplasty in the management of osteoarthritis" @default.
• W3019600400 doi "https://doi.org/10.1016/j.joca.2020.02.687" @default.
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