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Two-surgeon simultaneous bilateral total knee arthroplasty does not provide poor prosthetic alignment : A prospective

Fatih Yıldız1, Orkhan Aliyev2, Aghamazahir Aghazada2

  • 1Department of Orthopaedics and Traumatology, Bezmialem Vakıf University, İskender Paşa Mh Adnan Menderes Bulvarı, Adnan Menderes Blv., 34093, Fatih/Istanbul, Turkey. yildizfatih@hotmail.com.

Der Orthopade
|November 4, 2021
PubMed
Summary

Simultaneous bilateral total knee arthroplasty (TKA) performed by two surgeons is as safe and effective as sequential TKA performed by a single surgeon. This finding applies to both radiographic and functional outcomes in the short term.

Keywords:
AlignmentBilateralKneeRadiologic assessmentTwo-team

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Area of Science:

  • Orthopedic surgery
  • Arthroplasty
  • Biomedical engineering

Background:

  • Simultaneous bilateral total knee arthroplasty (TKA) is often considered complex due to potential logistical challenges.
  • Comparing two-surgeon simultaneous bilateral TKA with single-surgeon sequential bilateral TKA is crucial for optimizing patient outcomes and surgical efficiency.

Purpose of the Study:

  • To compare the radiological and functional outcomes of two-surgeon simultaneous bilateral TKA versus single-surgeon sequential bilateral TKA.
  • To evaluate the safety and efficacy of different bilateral TKA approaches.

Main Methods:

  • A prospective randomized study involving 136 participants (68 patients) with a minimum 24-month follow-up.
  • Participants were randomized into two groups: two-surgeon bilateral TKA and single-surgeon bilateral TKA.
  • Primary outcome: component alignment (coronal and sagittal planes). Secondary outcomes: functional results (Oxford Knee Score, WOMAC).

Main Results:

  • No significant differences were observed in key radiological parameters between the two groups, including tibial medial angle (TMA), femoral lateral angle (FLA), posterior tibial slope angle (PTSA), femoral flexion angle (FFA), anterior femoral offset ratio (AFOR), and posterior femoral offset ratio (PFOR).
  • Short-term functional outcomes, assessed by OKS and WOMAC scores, were comparable between the two-surgeon simultaneous and single-surgeon sequential bilateral TKA groups.
  • Radiological outcomes showed mean TMA of 89° ± 3° vs. 88° ± 5° (p=0.24), FLA of 87.9° ± 3.5° vs. 85.84° ± 3.7° (p=0.12), PTSA of 8.2° ± 16.9° vs. 7.6° ± 17.8° (p=0.84), FFA of 86.8° ± 3.8° vs. 86.3° ± 3.5° (p=0.41), AFOR of 29.5% ± 11.1 vs. 27.7% ± 7.9 (p=0.31), and PFOR of 108.41% ± 31.3 vs. 108.45% ± 25.7 (p=0.98).

Conclusions:

  • Two-team simultaneous bilateral TKA demonstrates comparable safety and efficacy to single-stage, single-surgeon sequential bilateral TKA.
  • The findings suggest that the two-surgeon approach is a viable alternative for bilateral TKA, yielding similar short-term radiological and functional results.
  • This study supports the use of simultaneous bilateral TKA as an effective surgical option when managed by two surgical teams.