[Simultaneous bilateral total knee arthroplasty in patients with rheumatoid arthritis]

In the event of destruction of both knee joints, is bilateral total arthroplasty a reliable operation that the patient can reasonably be expected to undergo?

In 140 patients [35 men, 105 women, average age 48.6 (range 24-78) years], a bilateral sequential TEP implantation was performed under one anaesthesia session, due to verified destruction of both knee joints (Larsen stage III-IV). All patients were treated with a cemented surface replacement prosthesis with resurfacing of the patella (Duracon Total Knee System, Stryker/Howmedica). Functional assessment was done with the aid of the Lysholm score preoperatively as well as 6, 12 and 18 months postoperatively.

The operation was conducted under one anaesthesia session in all patients. The average Lysholm scores improved from 26 (19-45) preoperatively, to 72 (49-81) 6 months postoperatively, 76 (48-85) 12 months postoperatively and 77 (49-87) 18 months postoperatively, whereby no significant difference between sides was observed. 96% of the patients said that they would undergo the operation again. The following complications occurred: 6 prosthesis infections (2.1%), 2 aseptic loosenings (0.7%), 8 superficial wound healing disorders (2.9%) and 2 deep vein thromboses (0.7%).

Sequential bilateral total knee arthroplasty under one anaesthesia session in patients with rheumatoid arthritis facilitates a much quicker rehabilitation, while the overall perioperative risk is not increased.