Compare Between the Complication of Simultaneous and Staged Bilateral Knee Replacement at King Abdulaziz Medical City (KAMC) - Riyadh

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Introduction: Total Knee replacement is a procedure commonly performed for degenerative joint disorder, e.g. osteoarthritis and rheumatoid arthritis. It is considered to be the most common and successful joint replacement. There will be an increase demand for the bilateral total knee replacement in the future due to increase of aging population and the indication to perform the surgery. There are controversies in the post surgical complication following simultaneous and staged bilateral total knee replacement; many studies have shown an increase in the mortality rate with simultaneous bilateral knee replacement. Other studies are showing evidence that suggest that there is no difference in the complication between simultaneous and staged bilateral total knee replacement. Methods: The study included 84 simultaneous BTKR, 110 staged BTKR (with time interval between the two 3 to 6 months) and 51 UTKR whom performed the surgery between January 2000 and August 2014. The collected data included demographic data, surgical data, complications and length of stay. We also have collected some variables of interest; Demographic (Gender, Age and Weight), Type of surgery (study groups), Hospital stay, Duration of procedure, Amount of bleeding, hemoglobin level before and after the operation and type of anesthesia. Results: We have a total of 245 patients. 110 (44.9%) underwent staged bilateral total knee replacement (BTKR), 84 underwent simultaneous bilateral total knee replacement (BTKR), and 51 of did the surgery on only one. The results showed that out of the 245, 194(79.18%) have not developed any complications, 62(73.81%) were simultaneous BTKR, 89(80.91%) of the staged BTKR and only 43(84.31%) were bilateral TKR. 43(17.55%) have developed minor complications which includes, Infection, UTI, Infected knee post operation or pulmonary complication other than pulmonary embolism. 18(21.43%) underwent simultaneous BTKR, 17(15.45%) for the staged BTKR and 8(15.69%) for the unilateral TKR. Only 8 patients have developed major complication (3.27%) of the general population. 4(4.76%) of the simultaneous BTKE and 4(3.64%) of the staged BTKR. None of the unilateral has developed major complication. We found a mean ± SE of the total days of hospital stay for all the groups was 12.58±. 52, for the simultaneous BTKR patients, the mean ± SE of hospital stay was 11.05±0.39 days, and for the staged was 16.19±1.31 days and 9.96±0.58 days, with a p value <.0001. Conclusion: We can say that simultaneous TKR is a save procedure to be performed especially in hospital where there is long waiting list as well difficulty of having elective bed as in our hospital. And we found out that patients whom underwent staged BTKR stayed at the hospital more than patients whom underwent simultaneous BTKR.