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Journal of Bone and Joint Surgery - British Volume, Vol 91-B, Issue 10, 1305-1309.
doi: 10.1302/0301-620X.91B10.22612  
Copyright © 2009 by British Editorial Society of Bone and Joint Surgery
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One-stage versus two-stage bilateral unicompartmental knee replacement

A COMPARISON OF IMMEDIATE POST-OPERATIVE COMPLICATIONS

W. C. W. Chan, MA, MBBChir, MRCS, Core Surgical Trainee 11; P. Musonda, MSc, PhD(Medstats), Honorary Lecturer, Medical Statistician2; A. S. Cooper, RGN, ONC, DipHE, Research Nurse1; M. M. S. Glasgow, FRCS(Orth), Consultant Orthopaedic Surgeon1; S. T. Donell, MD, FRCS(Orth), Consultant Orthopaedic Surgeon and Academic Reader1; and N. P. Walton, FRCS(Orth), Consultant Orthopaedic Surgeon1

1 Department of Orthopaedics Norwich and Norfolk University Hospital NHS Trust, Colney Lane, Norwich NR4 7UY, UK.
2 School of Medicine, Health Policy and Practice University of East Anglia, Chancellor’s Drive, Norwich NR4 7TJ, UK.

Correspondence should be sent to Mr W. C. W. Chan; e-mail: warwickchan{at}cantab.net

We retrospectively studied the major complications occurring after one- and two-stage bilateral unicompartmental knee replacements (UKR). Between 1999 and 2008, 911 patients underwent 1150 UKRs through a minimally invasive approach in our unit. Of these, 159 patients (318 UKRs) had one-stage and 80 patients (160 UKRs) had two-stage bilateral UKRs.

The bilateral UKR groups were comparable in age and American Society of Anaesthesiology grade, but more women were in the two-stage group (p = 0.019). Mechanical thromboprophylaxis was used in all cases. Major complications were recorded as death, pulmonary embolus, proximal deep-vein thrombosis and adverse cardiac events within 30 days of surgery. No statistical differences between the groups were found regarding the operating surgeon, the tourniquet time or minor complications except for distal deep-vein thrombosis. The anaesthetic times were longer for the two-stage group (p = 0.0001).

Major complications were seen in 13 patients (8.2%) with one-stage operations but none were encountered in the two-stage group (p = 0.005). Distal deep-vein thrombosis was more frequent in the two-stage group (p = 0.036).

Because of the significantly higher risk of major complications associated with one-stage bilateral UKR we advocate caution before undertaking such a procedure.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General