How Long to Wait Between Joint Arthroplasty Stages?

With staged bilateral total joint surgery, how much time should you leave between the two surgeries?

Researchers from Cleveland Clinic Florida and the Miami Orthopedics & Sports Medicine Institute reviewed a consecutive series of 670 primary staged bilateral total hip arthroplasties (THAs) and total knee arthroplasties (TKAs), calculating the days between both arthroplasties for each pair of hips or knees.

Their study, “Does the Timing of the Second Surgery of a Staged Bilateral Total Joint Arthroplasty Affect the Rate of Hospital Adverse Events and Perioperative Outcomes?” appears in the January 17, 2020 edition of The Journal of Arthroplasty.

Wael Barsoum, M.D., CEO and president of Cleveland Clinic Florida, and the Robert and Suzanne Tomsich Distinguished Chair in Healthcare Innovation described the rationale behind the study to OTW: “We observed that many adverse events that occur in hospitalized patients who underwent primary total hip or knee arthroplasty are not usually reflected in publications addressing complications after these procedures even though some of those ‘minor’ events (i.e., fever, tachycardia, nausea, vomiting) lead to additional costs in workup tests, interconsultations, and/or increased hospital length of stay.”

When in doubt, space them out.

“We found that the length of stay and the rates of hospital adverse events, total transfusions, and allogeneic transfusions were significantly lower in second arthroplasties performed more than a year apart from the first opposite joint when compared with those second arthroplasties performed within a year after the first contralateral arthroplasty.”

Dr. Barsoum told OTW, “The bottom line is that in the absence of factors such as health status or socioeconomic support, staging the second arthroplasty more than a year apart from the first one seems to offer a shorter hospital stay and better rates of adverse events and transfusions. When in face of bilateral THA or TKA, patients may be advised concerning this optimal timing between staged surgeries so that they can proceed with an informed decision.”