Bilateral total knee replacement under a single anaesthetic, using a cementless implant is not unsafe

Abstract

Bilateral knee replacement under single anaesthetic is not a common procedure. There is a general agreement that this is associated with greater morbidity and mortality. However, there is a suggestion in literature that using a cementless implant could reduce this risk. We wanted to make a prospective comparison of safety and clinical results, between unilateral and bilateral cementless knee replacements performed under a single anaesthetic. A prospective non-randomised matched cohort study on 87 consecutive patients who had bilateral simultaneous/sequential knee replacement and 174 consecutive patients who had unilateral knee replacement between the period of 1997 and 2002 were included in this study. All patients had a cementless mobile-bearing implant. All patients had an independent objective assessment at follow-up. There was no significant difference between the two groups in terms of age, sex, primary diagnosis (osteoarthritis or rheumatoid arthritis), co-morbidity, ASA grade, average range of motion and average American knee society score and post-operative surgical complications. There was one early death in the bilateral group, and three in the unilateral group. The clinical results of bilateral group were as good as the unilateral group. Our study showed that in terms of postoperative medical and surgical complications, bilateral simultaneous/sequential knee replacement using a cementless mobile-bearing implant is as safe as a unilateral knee replacement. With careful patient selection, bilateral knee replacement under a single anaesthetic would be a suitable option for patients who present with bilateral symptomatic arthritis of the knee.

Must Bilaterality Be Considered In Statistical Analyses of Total Knee Arthroplasty?

“…Although the bilateral TKA group had better maximum flexion and AKS function score, the differences were not large enough to be clinically meaningful. Our findings concur with those of previous studies reporting similar [10,26,50,52,57,58] or better [15,19,35,47] function of bilateral TKAs compared with unilateral TKAs ( Table 6). The patients undergoing bilateral TKAs achieved comparable outcomes despite worse preoperative clinical status.…”

“…This issue has been ignored in some studies [6,40]. Some studies have analyzed the function of bilateral TKAs without considering the independent contributions of each knee and regarding only the overall function of patient in the analyses [35,58], but in others an analysis was done on the assumption that each knee independently contributed to overall function or they did not clearly state how the knees in a patient undergoing bilateral TKAs were treated in the analyses [10,15,19,26,47,50,52,57] (Table 6). We found the alterations in mean, SE, and p value did not vary substantially depending on the four different methods.…”

“…In addition, whether patient function differs after bilateral and unilateral TKAs has been inconclusive in the literature. Some studies have reported better function in patients after bilateral TKAs than those undergoing a unilateral TKA [15,19,35,47], whereas others found no functional differences in patients having unilateral and bilateral TKAs [10,26,50,52,57,58]. Bilateral osteoarthritis of the knee is more frequent in Asian patients than in western patients, consequently bilateral TKAs are more frequently performed [25,26,60].…”

Perioperative Morbidity and Mortality of 2-team Simultaneous Bilateral Total Knee Arthroplasty

“…13 Confl icting studies exist in the orthopedic literature, with some demonstrating increased morbidity and mortality with simultaneous bilateral TKA, particularly in older patients and those with signifi cant medical comorbidities, 3,[6][7][8][13][14][15][16][17][18][19] and other studies showing similar safety profi les between simultaneous bilateral TKAs and unilateral or staged bilateral TKAs. 5,12,[20][21][22][23][24][25][26] We hypothesized that the morbidity and mortality rate of 2-team simultaneous bilateral TKAs was not signifi cantly different compared with unilateral TKAs at our institution.…”

The Influence of the Total Knee Prosthesis Applications (Bilateral, Simultaneous, Consecutive Bilateral or Single-Sided) on the Early Postoperative Complications

“…However, decision for simultaneous bilateral TKA should be made in case of suitable indication, if this is confirmed by the patient and in the direction of the preference of the patient. some surgeons avoid performing single-session application due to the more frequent complication risk (7)(8)(9)(10)(11)(12)(13). Actually, the condition of the patient determines the surgical risk.…”