Simultaneous bilateral total knee replacement: a prospective study of 150 patients

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering

Background:

• Osteoarthritis significantly impacts knee function and quality of life.
• Total knee replacement (TKR) is a common surgical intervention for advanced knee osteoarthritis.
• Simultaneous bilateral TKR offers potential benefits like reduced overall recovery time and cost.

Purpose of the Study:

• To assess the safety and efficacy of performing simultaneous bilateral total knee replacement (TKR).
• To evaluate functional outcomes and complication rates associated with this procedure.

Main Methods:

• 150 patients (124 women, 26 men; mean age 66) underwent simultaneous bilateral TKR with posterior-stabilized, high-flexion implants.
• Pre-operative cardiac assessment via dobutamine stress echocardiography was performed.
• Functional outcomes were measured using the Knee Society Score (KSS) and WOMAC index.
• Peri-operative measures included tranexamic acid, femoral blocks, and patient-controlled analgesia.

Main Results:

• Significant improvements were observed in range of motion (95° to 129°), KSS (120 to 158), and WOMAC scores (51 to 88) at 2-year follow-up.
• One case of patellar crepitus resolved conservatively.
• One patient experienced bilateral knee infection requiring salvage procedures and subsequent bilateral arthrodesis.
• No deep vein thrombosis, pulmonary embolism, or cardiac events occurred.

Conclusions:

• Simultaneous bilateral TKR demonstrates a favorable safety profile in carefully selected patients.
• The procedure leads to substantial improvements in knee function and patient-reported outcomes.
• Risk stratification and appropriate patient selection are crucial for successful outcomes.