Clinical Analysis Of Simultaneous And Staged Bilateral Total Knee And Total Hip Arthroplasty

Objective:By comparing the differences between simultaneous and staged bilateral total knee and total hip arthroplasty in terms of postoperative functional effect,postoperative complications,surgical risk,cost,postoperative recovery speed,in order to clarify the advantages and disadvantages of the two surgical methods.And to explore the cost-effective difference between the two surgical methods,in order to provide reference for the selection of simultaneous or staged surgical methods in clinical work.Methods:The clinical data of patients who underwent bilateral total knee arthroplasty(BTKA)and bilateral total hip arthroplasty(BTHA)in the Department of Orthopaedics of Qianfoshan Hospital of Shandong Province from January 1,2014 to December 31,2018 were collected.According to whether the patients underwent simultaneous bilateral joint replacement under single anesthesia,or underwent staged bilateral joint replacement(one side joint replacement was performed first,and then the other side joint replacement was performed after the patient recovered for a period of time)under twice anesthesia,the patients were divided into simultaneous operation group and staged operation group.After filtering,there were 50 cases in the simultaneous BTKA group,42 cases in the staged BTKA group,46 cases in the simultaneous BTHA group,and 30 cases in the staged BTHA group.Appropriate observation indexes(Knee WOMAC score,knee ROM,hip Harris score,squatting,FJS-12 score,postoperative complications,length of operation,length of hospital stay,blood transfusion,laboratory examination,cost,time required to recover to daily life basically unaffected after operation)were selected to compare the differences in postoperative functional effect,postoperative complications,risk,economic benefit and time benefit between the simultaneous group and the staged group,and then make a statistical analysis.Results:For BTKA patients:1.The postoperative functional effect of the simultaneous group was better than that of the staged group,which was as follows:(1)the postoperative knee joint ROM of the simultaneous group(116.30°±11.420°)was better than that of the staged group(101.67°±9.151°);(2)the postoperative WOMAC score of the simultaneous group(6.56±2.366)was better than that of the staged group(12.95±2.389);(3)The postoperative FJS-12 score of the simultaneous group(82.29±4.635)was better than that of the staged group(65.77±3.854).2.There was no significant difference in postoperative complications between the simultaneous group and the staged group.3.When compared from different aspects,the surgical risks of the two surgical methods are different.4.The total hospitalization expenses excluding the cost of prosthesis in the simultaneous group(23042.85±3282.09 yuan)was much lower than that in the staged group(35142.27±5373.14 yuan).5.The time required to recover to daily life basically unaffected after operation in the simultaneous group(3.990±1.391 months)was shorter than that in the staged group(7.810±3.563 months).For BTHA patients:1.The postoperative functional effect of the simultaneous group was better than that of the staged group,which was as follows:(1)the postoperative squatting condition of the simultaneous group was better than that of the staged group,(2)the postoperative HARRIS score of the simultaneous group(96.43±2.228)was better than that of the staged group(91.53±3.267);(3),and the postoperative FJS-12 score of the simultaneous group(86.957±2.614)was better than that of the staged group(72.014±9.440).2.There was no significant difference in postoperative complications between the simultaneous group and the staged group.3.When compared from different aspects,the surgical risks of the two surgical methods are different.4.The total hospitalization expenses excluding the cost of prosthesis in the simultaneous group(22552.07±2843.45 yuan)was much lower than that in the staged group(32635.40±6648.90 yuan).5.The time required to recover to daily life basically unaffected after operation in the simultaneous group(3.880±1.924 months)was shorter than that in the staged group(7.133±4.303 months).Conclusion:For patients with surgery indications of BTKA or BTHA,simultaneous BTKA and BTHA have better surgical effects than staged BTKA and BTHA if they are fully evaluated before the operation and the condition permits.Simultaneous bilateral group also have the advantages of lower cost of operation,shorter time required to recover to daily life basically unaffected after operation,and no increase in the incidence of postoperative complications.Therefore,the"cost-effective" ratio of simultaneous bilateral group is higher,and simultaneous bilateral group is more recommended.However,in some aspects,the surgical risk of patients undergoing simultaneous bilateral surgery is higher than that of patients with staged bilateral surgery.Therefore,for the elderly,for the patients with many preoperative complications,for patients with poor physical condition,for the patients with low preoperative hemoglobin,for patients with serious condition and long expected operation time,the simultaneous operation should be chosen carefully and strict preoperative evaluation and preparation should be made before operation.