Consensus Statement from the Consensus Conference on Bilateral Total Knee Arthroplasty Group
Consensus Statement from the Consensus Conference on Bilateral Total Knee Arthroplasty Group
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DOI：
10.1007/s11999-013-2976-9
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发表时间：
2013-08-01
影响因子：
4.2
通讯作者：
Sculco, Thomas P.
中科院分区：
文献类型：
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作者：
Memtsoudis, Stavros G.;Hargett, Mary;Sculco, Thomas P.
关于同日与分期双侧TKA（BTKA）相关的决策的许多方面存在争议，包括患者选择、围手术期管理决策和其他重要选择。在缺乏合适的随机试验的情况下，我们试图确定国家专家对以下问题的共识领域：（1）与单侧TKA（UTKA）和分期BTKA相比，当天BTKA的比较风险是什么？(2)谁应该被认为是当天BTKA的合适人选？(3)什么是BTKA的适当检查和围手术期管理？(4)如果认为当天BTKA不合适，手术之间的最佳时间是什么？(5)BTKA的矫形或康复考虑因素是否可能超过医疗禁忌症？在骨科手术、麻醉学、围手术期医学和流行病学国家专家共识会议的背景下，通过广泛的文献综述和改良的德尔菲方法，解决了围绕当天BTKA的主要问题。81%的参与者同意BTKA是更具侵入性和复杂的手术，与UTKA相比，在一组患者中，BTKA的围手术期不良事件风险增加。共识小组同意，医生和医院应考虑使用更严格的患者选择标准，并排除那些修改的心脏风险指数大于3的患者，以减轻潜在的风险增加。大多数人同意围手术期评估和管理应反映同日BTKA的更高水平。81%的参与者同意，如果患者不被视为当天BTKA的候选人，则应在第一次TKA后3个月内安排第二次TKA。整个小组同意，当矫形需求和当天BTKA的医疗充分性之间存在冲突时，对患者安全的医疗关注应优先于矫形需求。专家认为，当天BTKA增加了医疗风险，因此应采取系统的方法来管理患者，以尽量减少并发症。
Controversy exists regarding many aspects of decision making pertaining to same-day versus staged bilateral TKA (BTKAs), including patient selection, perioperative management decisions, and other important choices.In the absence of suitable randomized trials, we sought to determine areas of consensus among national experts on the following questions: (1) What are the comparative risks of same-day BTKAs compared with unilateral TKA (UTKA) and staged BTKAs? (2) Who should be considered an appropriate candidate for same-day BTKAs? (3) What constitutes appropriate workup and perioperative management for BTKAs? (4) What is the optimal time between procedures if same-day BTKAs are not deemed appropriate? (5) Are there orthopaedic or rehabilitation considerations for BTKAs that might outweigh medical contraindications?In the setting of a consensus conference of national experts in orthopaedic surgery, anesthesiology, perioperative medicine, and epidemiology, the major questions surrounding same-day BTKAs were addressed by using an extensive literature review and the modified Delphi process. The process concluded with a meeting of participants and formulation of consensus statements.Eighty-one percent of participants agreed that BTKAs are more invasive and complex procedures associated with increased risk for perioperative adverse events compared with UTKA in an unselected group of patients. The consensus group agreed that physicians and hospitals should consider using more restrictive patient selection criteria and exclude those with a modified cardiac risk index greater than 3 to mitigate the potentially increased risk. The majority of the group agreed that perioperative assessment and management should reflect the higher level of acuity of same-day BTKAs. Eighty-one percent of participants agreed that if a patient is not deemed a candidate for same-day BTKAs, a second TKA should be scheduled no sooner than 3 months after the first. The entire group agreed that when there is a conflict between the orthopaedic need and the medical adequacy of same-day BTKAs, the medical concern for the patient's safety should prevail over the orthopaedic need.Experts perceived that same-day BTKAs increase medical risk, and thus a systematic approach to the management of patients should be taken to minimize complications.