Staged bilateral total knee replacement: changes in expectations and outcomes between the first and second...

Area of Science:

• Orthopedics
• Reconstructive Surgery

Background:

• Symmetrical degenerative joint disease and deformity often necessitate bilateral total knee replacement (TKR).
• Staged bilateral TKR allows for recovery between procedures but may influence patient expectations and outcomes.

Purpose of the Study:

• To evaluate patient expectations, functional outcomes, and satisfaction following staged bilateral total knee replacement (TKR).
• To compare outcomes between the first (TKR1) and second (TKR2) TKR procedures in patients with symmetrical knee conditions.

Main Methods:

• A prospective study of 70 patients undergoing 140 staged bilateral TKRs between 2009 and 2011.
• Patients were assessed pre-operatively and at 6 and 12 months post-operatively using Short Form-12, Oxford Knee Score (OKS), expectation, and satisfaction questionnaires.

Main Results:

• The pre-operative Oxford Knee Score (OKS) was significantly worse before TKR1, with greater improvement seen after TKR1 compared to TKR2.
• Patient satisfaction was high for both TKR1 (93%) and TKR2 (87%), but satisfaction levels did not correlate within individuals.
• Expectations for pain relief and stair-climbing decreased before TKR2, while expectations for sports and social activities increased.

Conclusions:

• Satisfaction with one total knee replacement (TKR) does not guarantee similar satisfaction with a second staged TKR.
• Functional improvement may be more pronounced after the initial TKR, and patient expectations evolve between staged procedures.