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Subsequent total joint arthroplasty: Are we learning from the first stage?

Publication ,  Journal Article
Wu, CJ; Penrose, C; Ryan, SP; Bolognesi, MP; Seyler, TM; Wellman, SS
Published in: World J Orthop
March 18, 2024

BACKGROUND: With the increasing incidence of total joint arthroplasty (TJA), there is a desire to reduce peri-operative complications and resource utilization. As degenerative conditions progress in multiple joints, many patients undergo multiple procedures. AIM: To determine if both physicians and patients learn from the patient's initial arthroplasty, resulting in improved outcomes following the second procedure. METHODS: The institutional database was retrospectively queried for primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). Patients with only unilateral THA or TKA, and patients undergoing same-day bilateral TJA, were excluded. Patient demographics, comorbidities, and implant sizes were collected at the time of each procedure and patients were stratified by first vs second surgery. Outcome metrics evaluated included operative time, length of stay (LOS), disposition, 90-d readmissions and emergency department (ED) visits. RESULTS: A total of 642 patients, including 364 undergoing staged bilateral TKA and 278 undergoing bilateral THA, were analyzed. There was no significant difference in demographics or comorbidities between the first and second procedure, which were separated by a mean of 285 d. For THA and TKA, LOS was significantly less for the second surgery, with 66% of patients having a shorter hospitalization (P < 0.001). THA patients had significantly decreased operative time only when the same sized implant was utilized (P = 0.025). The vast majority (93.3%) of patients were discharged to the same type of location following their second surgery. However, when a change in disposition was present from the first surgery, patients were significantly more likely to be discharged to home after the second procedure (P = 0.033). There was no difference between procedures for post-operative readmissions (P = 0.438) or ED visits (P = 0.915). CONCLUSION: After gaining valuable experience recovering from the initial surgery, a patient's perioperative outcomes are improved for their second TJA. This may be the result of increased confidence and decreased anxiety, and it supports the theory that enhanced patient education pre-operatively may improve outcomes. For the surgical team, the second procedure of a staged THA is more efficient, although this finding did not hold for TKA.

Duke Scholars

Published In

World J Orthop

DOI

ISSN

2218-5836

Publication Date

March 18, 2024

Volume

15

Issue

3

Start / End Page

230 / 237

Location

United States

Related Subject Headings

  • 3202 Clinical sciences
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Wu, C. J., Penrose, C., Ryan, S. P., Bolognesi, M. P., Seyler, T. M., & Wellman, S. S. (2024). Subsequent total joint arthroplasty: Are we learning from the first stage? World J Orthop, 15(3), 230–237. https://doi.org/10.5312/wjo.v15.i3.230
Wu, Christine Jiang, Colin Penrose, Sean Patrick Ryan, Michael Paul Bolognesi, Thorsten Markus Seyler, and Samuel Secord Wellman. “Subsequent total joint arthroplasty: Are we learning from the first stage?World J Orthop 15, no. 3 (March 18, 2024): 230–37. https://doi.org/10.5312/wjo.v15.i3.230.
Wu CJ, Penrose C, Ryan SP, Bolognesi MP, Seyler TM, Wellman SS. Subsequent total joint arthroplasty: Are we learning from the first stage? World J Orthop. 2024 Mar 18;15(3):230–7.
Wu, Christine Jiang, et al. “Subsequent total joint arthroplasty: Are we learning from the first stage?World J Orthop, vol. 15, no. 3, Mar. 2024, pp. 230–37. Pubmed, doi:10.5312/wjo.v15.i3.230.
Wu CJ, Penrose C, Ryan SP, Bolognesi MP, Seyler TM, Wellman SS. Subsequent total joint arthroplasty: Are we learning from the first stage? World J Orthop. 2024 Mar 18;15(3):230–237.

Published In

World J Orthop

DOI

ISSN

2218-5836

Publication Date

March 18, 2024

Volume

15

Issue

3

Start / End Page

230 / 237

Location

United States

Related Subject Headings

  • 3202 Clinical sciences