Subsequent total joint arthroplasty: Are we learning from the first stage?  

作　　者：Christine Jiang Wu Colin Penrose Sean Patrick Ryan Michael Paul Bolognesi Thorsten Markus Seyler Samuel Secord Wellman 

机构地区：[1]Department of Orthopaedic Surgery,Duke University Hospital,Durham,NC 27710,United States [2]Department of Orthopaedic Surgery,Midwest Center for Joint Replacement,Indianapolis,IN 46241,United States

出　　处：《World Journal of Orthopedics》2024年第3期230-237,共8页世界骨科杂志（英文版）

摘　　要：BACKGROUND With the increasing incidence of total joint arthroplasty(TJA),there is a desire to reduce peri-operative complications and resource utilization.As degenerative conditions progress in multiple joints,many patients undergo multiple proce-dures.AIM To determine if both physicians and patients learn from the patient’s initial arth-roplasty,resulting in improved outcomes following the second procedure.METHODS The institutional database was retrospectively queried for primary total hip arth-roplasty(THA)and total knee arthroplasty(TKA).Patients with only unilateral THA or TKA,and patients undergoing same-day bilateral TJA,were excluded.Patient demographics,comorbidities,and implant sizes were collected at the time of each procedure and patients were stratified by first vs second surgery.Outcome metrics evaluated included operative time,length of stay(LOS),disposition,90-d readmissions and emergency department(ED)visits.RESULTS A total of 642 patients,including 364 undergoing staged bilateral TKA and 278 undergoing bilateral THA,were analyzed.There was no significant difference in demographics or comorbidities between the first and second procedure,which were separated by a mean of 285 d.For THA and TKA,LOS was significantly less for the second surgery,with 66%of patients having a shorter hospitalization(P<0.001).THA patients had significantly decreased operative time only when the same sized implant was utilized(P=0.025).The vast majority(93.3%)of patients were discharged to the same type of location following their second surgery.However,when a change in disposition was present from the first surgery,patients were significantly more likely to be discharged to home after the second procedure(P=0.033).There was no difference between procedures for post-operative readmissions(P=0.438)or ED visits(P=0.915).CONCLUSION After gaining valuable experience recovering from the initial surgery,a patient’s perioperative outcomes are improved for their second TJA.This may be the result of increased confidence and de

关 键 词：Staged total joint arthroplasty Asynchronous total joint arthroplasty Subsequent total joint arthroplasty Contralateral total joint arthroplasty Perioperative outcomes 

分 类 号：R687.4[医药卫生—骨科学]