Complications after concomitant bilateral total knee arthroplasty in elderly patients

To determine the risks associated with performance of bilateral total knee arthroplasty (TKA) in elderly patients.

Ninety-eight patients with osteoarthritis who were 80 years of age or older and underwent concomitant cemented bilateral TKA were matched (on the basis of gender, surgeon, year of surgical treatment, age, and diagnosis) with 98 patients who underwent cemented unilateral TKA to compare the number and types of complications in these two groups. The groups did not differ in the number and type or severity of premorbid medical conditions, anesthetic risk, and type of anesthesia.

One hundred nineteen postoperative complications occurred in 63 patients in the bilateral TKA group; in contrast, 72 complications occurred in 49 patients in the unilateral TKA group. The difference between the two groups in the total number of complications was significant. Specifically, significant differences between the two groups were noted in the occurrence of cardiovascular and neurologic complications. On paired analysis, congestive heart failure and acute delirium were found to be significantly more frequent in the bilateral TKA group than in the unilateral TKA group. We noted a trend toward an increased mortality rate in the bilateral group (four patients) versus the unilateral group (no deaths).

Patients 80 years of age or older who undergo concomitant bilateral TKA are at increased risk for cardiovascular and neurologic complications during the postoperative period in comparison with matched patients who undergo unilateral TKA.