Which Patients Require a Contralateral Total Knee Arthroplasty Within 5 Years of Index Surgery?

Abstract

Osteoarthritis (OA) of the knee often presents bilaterally. However, not all patients with severe bilateral knee OA require bilateral total knee arthroplasty (TKA). This study aims to identify predictive factors for contralateral TKA in patients presenting with severe bilateral knee OA undergoing unilateral TKA. We prospectively collected perioperative data from 209 consecutive patients of a single surgeon who had severe bilateral OA knees at presentation. All patients underwent unilateral TKA on the more symptomatic knee. Patients were then stratified by their need for a contralateral TKA within the next 5 years. Using regression analysis, we compared patients who underwent contralateral knee surgery within 5 years (n = 115) against patients who did not (n = 94), so as to create a predictive model. Significant factors identified by the multiple regression models were incorporated into a decision tree using classification and regression tree analysis. Body mass index (BMI), degree of varus angulation, and Oxford knee scores were identified as significant predictive factors. The generated decision tree model was able to stratify patients according to their BMI and Oxford scores into four subgroups, the highest with more than 90% odds of contralateral surgery and the lowest with less than 40% odds of contralateral surgery. BMI, degree of varus angulation, and preoperative Oxford knee scores seem to predict the need for contralateral TKA in patients with severe bilateral OA knees undergoing unilateral TKA. These patients should be counseled on their requirement for the second TKA based on these factors.

Keywords

osteoarthritis - knee osteoarthritis - total knee replacement - total knee arthroplasty - bilateral knee osteoarthritis

Ethical Approval

This study was approved by our Hospital's Institutional Review Board (IRB) and performed in accordance to the ethical standards laid down in 1964 declaration of Helsinki.

Publication History

Received: 04 September 2018

Accepted: 05 May 2019

Article published online:
16 July 2019

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