Bilateral Total Arthroplasty Research Articles

Simultaneous Bilateral Total Knee Arthroplasty: What Is the Value? Commentary on an article by Susan M. Odum, PhD, and Bryan D. Springer, MD: "In-Hospital Complication Rates and Associated Factors After Simultaneous Bilateral Versus Unilateral Total Knee Arthroplasty".

Total knee arthroplasty has long been shown to be both safe and efficacious for the treatment of degenerative conditions of the knee—relieving pain, restoring function, correcting deformity, and providing measurable improvements in quality of life. Total knee arthroplasty also has been demonstrated to be very cost-effective from a societal perspective, with estimates between ten and twenty thousand dollars per quality-adjusted life year (QALY)1. Frequently, patients present with bilateral symptomatic disease and deformity, prompting patients and surgeons to consider simultaneous bilateral total knee arthroplasty. The number of total knee arthroplasties performed and rate of utilization in the United States has grown exponentially over the last several decades. In fact, more than 700,000 were performed in 2010, with projections of more than three million total knee arthroplasties expected to be performed annually by 20302. The surgical demand creates major financial strains on the American health-care system and, in part, is responsible for the pay-for-performance measures enacted by the Centers for Medicare & Medicaid Services (CMS) and the recent public reporting of outcomes for total hip and total knee arthroplasty surgery. Simultaneous bilateral total knee arthroplasty has represented a consistent 4% to 6% of total knee arthroplasties performed annually in the United States1,3,4. Despite a lengthy history of surgeons performing simultaneous bilateral total knee arthroplasty, there continues to be debate about the indications for the procedure and concern regarding its overall safety. Those surgeons who support the use of simultaneous bilateral total knee arthroplasty cite decreased cost, improved recovery time, the utilization of a single anesthetic, and equal functional outcomes when compared with staged bilateral total knee arthroplasty. Those surgeons who favor staged bilateral total knee arthroplasty cite increased mortality, both in-hospital and within thirty days …

Einzeitiger bilateraler Kniegelenkersatz bei Patienten mit Rheumatoider Arthritis

In the event of destruction of both knee joints, is bilateral total arthroplasty a reliable operation that the patient can reasonably be expected to undergo? In 140 patients [35 men, 105 women, average age 48.6 (range 24-78) years], a bilateral sequential TEP implantation was performed under one anaesthesia session, due to verified destruction of both knee joints (Larsen stage III-IV). All patients were treated with a cemented surface replacement prosthesis with resurfacing of the patella (Duracon Total Knee System, Stryker/Howmedica). Functional assessment was done with the aid of the Lysholm score preoperatively as well as 6, 12 and 18 months postoperatively. The operation was conducted under one anaesthesia session in all patients. The average Lysholm scores improved from 26 (19-45) preoperatively, to 72 (49-81) 6 months postoperatively, 76 (48-85) 12 months postoperatively and 77 (49-87) 18 months postoperatively, whereby no significant difference between sides was observed. 96% of the patients said that they would undergo the operation again. The following complications occurred: 6 prosthesis infections (2.1%), 2 aseptic loosenings (0.7%), 8 superficial wound healing disorders (2.9%) and 2 deep vein thromboses (0.7%). Sequential bilateral total knee arthroplasty under one anaesthesia session in patients with rheumatoid arthritis facilitates a much quicker rehabilitation, while the overall perioperative risk is not increased.

Single-stage bilateral total hip arthroplasty.

The number of single-stage bilateral total hip arthroplasties done each year is increasing. The risk of postoperative complications in medically stable patients is acceptable; complications are approximately 1.3 times more frequent than with unilateral total hip arthroplasty. Although there are no absolute indications for a single-stage bilateral total hip arthroplasty, the procedure is usually contraindicated in patients with such comorbidities as heart disease, pulmonary insufficiency, or diabetes, and it is absolutely contraindicated in patients with a documented patent ductus arteriosus or septal defect. The primary postoperative concern is that the cardiopulmonary insult associated with two surgical wounds and surgeries can lead to an increase in thromboembolic events. The cost for single-stage bilateral total arthroplasty is less than that for a two-stage bilateral total hip arthroplasty, with savings predominantly due to reduced length of acute hospital stay. However, the decision to undergo single-stage bilateral total hip arthroplasty is one that must be made in concert with the patient.