Best timing of bilateral knee arthroplasty– an analysis of revision and mortality rates from the German Arthroplasty Registry (EPRD)
Abstract Background The burden of osteoarthritis (OA) in multiple joints is high. For patients with bilateral knee OA there is no clear recommendation when to time the second surgery. The purpose of this study was therefore to compare revision and mortality rate in bilateral unicondylar and bicondyl...
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BMC
2025-03-01
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| Series: | BMC Musculoskeletal Disorders |
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| Online Access: | https://doi.org/10.1186/s12891-025-08548-5 |
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| author | Anne Elisabeth Postler Paula Krull Yinan Wu Klaus-Peter Günther Oliver Melsheimer Arnd Steinbrück Jörg Lützner |
| author_facet | Anne Elisabeth Postler Paula Krull Yinan Wu Klaus-Peter Günther Oliver Melsheimer Arnd Steinbrück Jörg Lützner |
| author_sort | Anne Elisabeth Postler |
| collection | DOAJ |
| description | Abstract Background The burden of osteoarthritis (OA) in multiple joints is high. For patients with bilateral knee OA there is no clear recommendation when to time the second surgery. The purpose of this study was therefore to compare revision and mortality rate in bilateral unicondylar and bicondylar knee arthroplasties after different strategies of surgical timing in bilateral knee OA from the German Arthroplasty Registry (EPRD). Methods Data from the German Arthroplasty Registry (EPRD) was used. Since 2012 a total of 15,154 patients had bilateral knee arthroplasty within one year. Patellofemoral arthroplasties and constraint total knee arthroplasties (TKA) were excluded. 1,144 TKA and 682 unicondylar arthroplasties (UKA) were simultaneously performed, 772 TKA and 292 UKA between 1 and 90 days (short interval) and 24,496 TKA and 2,922 UKA between 91 and 365 days (intermediate interval). Revision and mortality rates were analyzed up to 7 years after surgery. Cox regression was performed to evaluate the influence of different patient characteristics on these outcomes. Results The highest cumulative revision rate for any of the bilateral TKA was found for simultaneous surgery with 3.4% (95% CI 2.1–5.5). Lower risk for revision was seen in two-staged surgery in short interval (HR 0.42; 95% CI 0.20–0.90) and intermediate interval (HR 0.58; 95% CI 0.39–0.85). The cumulative one year mortality rate for TKA was comparable in all three groups with 0.8% for simultaneous TKA, 1.3% for short interval two-staged and 0.7% for intermediate interval. In UKA there were no differences between the groups regarding cumulative revision rate and mortality rate. Conclusion TKA should be performed simultaneously in selected patients only, the two-staged procedure demonstrated lower revision risks. For UKA we found no differences in timing, simultaneous surgery seems to be a safe option. Trial registration Clinical trial number not applicable. Level of evidence III. |
| format | Article |
| id | doaj-art-514ebd8f8d8347c1a9ac344ac4cb3079 |
| institution | OA Journals |
| issn | 1471-2474 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Musculoskeletal Disorders |
| spelling | doaj-art-514ebd8f8d8347c1a9ac344ac4cb30792025-08-20T02:26:58ZengBMCBMC Musculoskeletal Disorders1471-24742025-03-012611810.1186/s12891-025-08548-5Best timing of bilateral knee arthroplasty– an analysis of revision and mortality rates from the German Arthroplasty Registry (EPRD)Anne Elisabeth Postler0Paula Krull1Yinan Wu2Klaus-Peter Günther3Oliver Melsheimer4Arnd Steinbrück5Jörg Lützner6University Center of Orthopaedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, TUD Dresden University of TechnologyGerman Arthroplasty Registry (EPRD)German Arthroplasty Registry (EPRD)University Center of Orthopaedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, TUD Dresden University of TechnologyGerman Arthroplasty Registry (EPRD)German Arthroplasty Registry (EPRD)University Center of Orthopaedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, TUD Dresden University of TechnologyAbstract Background The burden of osteoarthritis (OA) in multiple joints is high. For patients with bilateral knee OA there is no clear recommendation when to time the second surgery. The purpose of this study was therefore to compare revision and mortality rate in bilateral unicondylar and bicondylar knee arthroplasties after different strategies of surgical timing in bilateral knee OA from the German Arthroplasty Registry (EPRD). Methods Data from the German Arthroplasty Registry (EPRD) was used. Since 2012 a total of 15,154 patients had bilateral knee arthroplasty within one year. Patellofemoral arthroplasties and constraint total knee arthroplasties (TKA) were excluded. 1,144 TKA and 682 unicondylar arthroplasties (UKA) were simultaneously performed, 772 TKA and 292 UKA between 1 and 90 days (short interval) and 24,496 TKA and 2,922 UKA between 91 and 365 days (intermediate interval). Revision and mortality rates were analyzed up to 7 years after surgery. Cox regression was performed to evaluate the influence of different patient characteristics on these outcomes. Results The highest cumulative revision rate for any of the bilateral TKA was found for simultaneous surgery with 3.4% (95% CI 2.1–5.5). Lower risk for revision was seen in two-staged surgery in short interval (HR 0.42; 95% CI 0.20–0.90) and intermediate interval (HR 0.58; 95% CI 0.39–0.85). The cumulative one year mortality rate for TKA was comparable in all three groups with 0.8% for simultaneous TKA, 1.3% for short interval two-staged and 0.7% for intermediate interval. In UKA there were no differences between the groups regarding cumulative revision rate and mortality rate. Conclusion TKA should be performed simultaneously in selected patients only, the two-staged procedure demonstrated lower revision risks. For UKA we found no differences in timing, simultaneous surgery seems to be a safe option. Trial registration Clinical trial number not applicable. Level of evidence III.https://doi.org/10.1186/s12891-025-08548-5Total knee arthroplastyUnicondylar knee arthroplastyBilateralSame daySimultaneousMortality |
| spellingShingle | Anne Elisabeth Postler Paula Krull Yinan Wu Klaus-Peter Günther Oliver Melsheimer Arnd Steinbrück Jörg Lützner Best timing of bilateral knee arthroplasty– an analysis of revision and mortality rates from the German Arthroplasty Registry (EPRD) BMC Musculoskeletal Disorders Total knee arthroplasty Unicondylar knee arthroplasty Bilateral Same day Simultaneous Mortality |
| title | Best timing of bilateral knee arthroplasty– an analysis of revision and mortality rates from the German Arthroplasty Registry (EPRD) |
| title_full | Best timing of bilateral knee arthroplasty– an analysis of revision and mortality rates from the German Arthroplasty Registry (EPRD) |
| title_fullStr | Best timing of bilateral knee arthroplasty– an analysis of revision and mortality rates from the German Arthroplasty Registry (EPRD) |
| title_full_unstemmed | Best timing of bilateral knee arthroplasty– an analysis of revision and mortality rates from the German Arthroplasty Registry (EPRD) |
| title_short | Best timing of bilateral knee arthroplasty– an analysis of revision and mortality rates from the German Arthroplasty Registry (EPRD) |
| title_sort | best timing of bilateral knee arthroplasty an analysis of revision and mortality rates from the german arthroplasty registry eprd |
| topic | Total knee arthroplasty Unicondylar knee arthroplasty Bilateral Same day Simultaneous Mortality |
| url | https://doi.org/10.1186/s12891-025-08548-5 |
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