Evidence map›Paper›PMID 27167849›Full record

ArticleActa orthopaedica2016

Outcomes of unilateral and bilateral total knee arthroplasty in 238,373 patients.

Eric R Bohm, Katy Molodianovitsh, Alina Dragan, Naisu Zhu, Greg Webster, Bas Masri, Emil Schemitsch, Michael Dunbar

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Acta orthopaedica, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 41 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
41citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

41 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Hospital volume-outcome relationship in total knee arthroplasty: a systematic review and dose-response meta-analysis.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2022
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Eric R Bohma Department of Surgery , University of Manitoba , Winnipeg , Manitoba ;
Katy Molodianovitshb Canadian Institute for Health Information , Ottawa , Ontario ;
Alina Draganb Canadian Institute for Health Information , Ottawa , Ontario ;
Naisu Zhub Canadian Institute for Health Information , Ottawa , Ontario ;
Greg Websterb Canadian Institute for Health Information , Ottawa , Ontario ;
Bas Masric Department of Orthopaedic Surgery , University of British Columbia , Vancouver , British Columbia ;
Emil Schemitschd Department of Surgery , University of Toronto , Toronto , Ontario ;
Michael Dunbarb Canadian Institute for Health Information , Ottawa , Ontario ;

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background and purpose - There is no consensus about the outcome of simultaneous vs. staged bilateral total knee arthroplasty (TKA). We examined this issue by analyzing 238,373 patients. Patients and methods - Demographic, clinical, and outcome data were evaluated for TKA patients (unilateral: 206,771; simultaneous bilateral: 6,349; staged bilateral: 25,253) from the Canadian Hospital Morbidity Database for fiscal years 2006-2007 to 2012-2013. Outcomes were adjusted for age, sex, comorbidities, and hospital TKA volume. Results - Simultaneous bilateral TKA patients were younger than staged bilateral TKA patients (median 64 years vs. 66 years), were more likely to be male (41% vs. 39%), and had a lower frequency of having ≥1 comorbid condition (2.9% vs. 4.2%). They also had a higher frequency of blood transfusions (41% vs. 19%), a shorter median length of stay (6 days vs. 8 days), a higher frequency of transfer to a rehabilitation facility (46% vs. 9%), and a lower frequency of knee infection (0.5% vs. 0.9%) than staged bilateral TKA patients, but they had higher rate of cardiac complications within 90 days (2.0% vs. 1.7%). Simultaneous patients had higher in-hospital mortality compared to the second TKA in staged patients (0.16% vs. 0.06%), but they had similar rates of in-hospital mortality compared to unilateral patients (0.16% vs. 0.14%). The cumulative 3-year revision rate was highest in the unilateral group (2.3%), but it was similar in the staged and simultaneous bilateral groups (1.4%). Interpretation - We found important differences between the outcomes of simultaneous and staged bilateral TKA. Further clarification of outcomes would be best determined in an adequately powered randomized trial, which would remove the selection bias inherent in this retrospective study design.

Indexed as

AgedArthroplasty, Replacement, KneeCanadaDatabases, FactualFemaleHospital MortalityHumansLength of StayLogistic ModelsMaleMiddle AgedOsteoarthritis, KneePostoperative ComplicationsReoperationRetrospective StudiesTreatment Outcome

Identifiers

PMID27167849
PMCPMC4937774

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.