Hip and knee arthroplasty in one surgical session: early morbi-mortality study - 30/07/24

Doi : 10.1016/j.otsr.2024.103955

Henri Favreau ^a,^b,^c,⁎ , Jean-Luc Raynier ^d, Thomas Rousseau ^e, Sébastien Lustig ^f, François Bonnomet ^a,^b,^c, Christophe Trojani ^d
^a Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre 2, Hôpitaux Universitaires de Strasbourg, 1 avenue Molière, 67098 Strasbourg cedex, France
^b Laboratory INSERM UMR 1260, Regenerative Nanomedicine Centre de Recherche en Biomédecine de Strasbourg (CRBS), 1 rue Eugène Boeckel, 67084 Strasbourg Cedex, France
^c ICube Laboratory, CNRS UMR 7357, 30 Bd Sébastien Brant, 67400 Illkirch, France
^d ICR, Institut de Chirurgie Réparatrice Locomoteur et du Sport, 7 avenue Durante, 06000 Nice, France
^e Clinique Mutualiste Catalane, 60 rue Louis Mouillard 66000 Perpignan, France
^f Orthopaedic Department, Lyon North University Hospital, Hopital de La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004 Lyon, France

^⁎Corresponding author.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Tuesday 30 July 2024

Abstract

Introduction

Bilateral prosthetic hip or knee replacement in one surgical session is a procedure that has been widely validated in the literature, whereas hip and knee replacement in one surgical session remains poorly documented. This study reports on the results of these procedures by analyzing early post-operative complications in a retrospective multicenter study.

Material and methods

Between 2009 and 2023, 51 patients underwent hip and knee replacement surgery in a single surgical session at 4 French centers. They were 24 men and 27 women, with a mean age of 68.8 years (36–87); 7 patients were ASA 1, 30 were ASA 2 and 14 ASA 3. Prosthetic hip replacement was always performed first, associated 33 times with the ipsi-lateral knee and 18 times with the contralateral knee. All early complications, within the first 90 days post-operatively, were recorded: death, phlebitis, pulmonary embolism, myocardial infarction, surgical site infection (SSI), knee stiffness treated by mobilization under general anesthesia, urinary tract infection, acute urine retention or any other adverse event related to care. Transfusion rates were also reported.

Results

The rate of early complications was 9.8% (5/51). No deaths, no phlebitis, no pulmonary embolism and no SSI were observed. Complications included one myocardial infarction, one urinary tract infection, one superficial infection, one haematoma treated by surgical evacuation and one recurrent instability requiring revision surgery (hip arthroplasty). The transfusion rate was 17.6% (9/51). The complication rate of ASA 3 patients was higher than that of ASA 1 and 2 patients, while there was no difference related to age or BMI.

Discussion

Our results confirm the feasibility of single-stage hip and knee replacement, with a low complication rate in ASA 1 and 2 patients. This study adds to the few published works on the subject and reports comparable results. The small sample size and the heterogeneity of patients and centers limit the scope of the results, these limitations being relative to the volume expected for a rare procedure.

Conclusion

Single-session hip and knee arthroplasty should be reserved for patients selected according to comorbidities: ASA score, age and body mass index. ASA 3 patients have a higher risk of complications.