Chronic Disease

Older patients with chronic conditions have greater risk of problems and death following bilateral knee replacement

Patients needing knee replacement surgery may decide to have both knees done at the same time. While certainly a cost-saving measure, this surgery may also result in increased risk of problems and death for the patient. Understanding which patients may be at risk can help clinicians risk-stratify patients to determine who will have the best outcomes. A new study has identified patient-related risk factors that increase morbidity and mortality in these patients. Often, those most at risk are older patients with certain chronic health conditions.

The researchers analyzed data from 1998 to 2007 as part of the Nationwide Inpatient Survey to identify cases of bilateral knee replacement surgery. During the time period studied, an estimated 206,573 bilateral total knee replacements were performed. About 9.5 percent of patients developed major complications or died while in the hospital. Patients most likely to suffer complications or death were older, male, and white. Patients younger than 45 years of age were half as likely to have a major complication or die than patients between 45 and 64 years of age and one-third as likely to have problems or die than patients aged 65 to 74.

After surgery, the majority of complications were cardiac in nature. Comorbidities associated with major complications or mortality included congestive heart failure and pulmonary hypertension. Given the findings, the researchers suggest that national, evidence-based guidelines be established to help physicians and patients decide if they want to have both knees replaced at the same time. This study was funded in part by a grant from the Agency for Healthcare Research and Quality (HS16075) to the Hospital for Special Surgery's Center for Education and Research in Therapeutics (CERT).

For more information on the CERTs program, visit http://www.certs.hhs.gov.

See "Bilateral total knee arthroplasty: Risk factors for major morbidity and mortality," by Stavros G. Memtsoudis, M.D., Ph.D., Yan Ma, Ph.D., Ya-Lin Chiu, M.S, and others in the October 2011 Anesthesia and Analgesia 113, pp. 784-790.

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