Sequential Bilateral Total Knee Arthroplasty Research Articles

Does the accelerometer-based navigation system reduce blood loss and transfusion in one-stage sequential bilateral total knee arthroplasty? A randomized double-blind controlled trial

BackgroundTotal knee arthroplasty (TKA) is associated with significant blood loss and postoperative transfusion. The accelerometer-based navigation (ABN) system guides the bone cutting plane without breaching the intramedullary canal, which may reduce bleeding. This study aimed to investigate blood loss and transfusion compared between the ABN system and the conventional procedure in patients undergoing one-stage sequential bilateral TKA (SBTKA).MethodsA total of 66 patients scheduled for SBTKA were randomly allocated to either the ABN or conventional group. Postoperative hematocrit (Hct) level, drainage blood loss, transfusion rate, and amount of packed red cell transfusion were collected. Total red blood cell (RBC) loss was then calculated for the primary outcome.ResultsThe mean calculated total RBC loss in the ABN and conventional group was 669.7 and 630.0 mL, respectively (p = 0.572). There was no significant difference between groups for other evaluated outcome parameters, including postoperative Hct level, drainage blood loss, or packed red cell transfusion volume. All patients in the conventional group required postoperative blood transfusion while 96.8% of patients in the ABN group were transfused.ConclusionsThe total RBC loss and volume of packed red cells transfusion were not significant difference between interventions, which suggest no benefit of the ABN system in reducing blood loss and transfusion in patients undergoing SBTKA.Trial registrationThe protocol of this study was registered in the Thai Clinical Trials Registry database no. TCTR20201126002 on 26/11/2020.

The Trochlear Groove of a Femoral Component Designed for Kinematic Alignment Is Lateral to the Quadriceps Line of Force and Better Laterally Covers the Anterior Femoral Resection Than a Mechanical Alignment Design.

Background: A concern about kinematically aligned (KA) total knee arthroplasty (TKA) is that it relies on femoral components designed for mechanical alignment (MAd-FC) that could affect patellar tracking, in part, because of a trochlear groove orientation that is typically 6° from vertical. KA sets the femoral component coincident to the patient’s pre-arthritic distal and posterior femoral joint lines and restores the Q-angle, which varies widely. Relative to KA and the native knee, aligning the femoral component with MA changes most distal joint lines and Q-angles, and rotates the posterior joint line externally laterally covering the anterior femoral resection. Whether switching from a MAd- to a KAd-FC with a wider trochlear groove orientation of 20.5° from vertical results in radiographic measures known to promote patellar tracking is unknown. The primary aim was to determine whether a KAd-FC sets the trochlear groove lateral to the quadriceps line of force (QLF), better laterally covers the anterior femoral resection, and reduces lateral patella tilt relative to a MAd-FC. The secondary objective was to determine at six weeks whether the KAd-FC resulted in a higher complication rate, less knee extension and flexion, and lower clinical outcomes. Methods: Between April 2019 and July 2022, two surgeons performed sequential bilateral unrestricted caliper-verified KA TKA with manual instruments on thirty-six patients with a KAd- and MAd-FC in opposite knees. An observer measured the angle between a line best-fit to the deepest valley of the trochlea and a line representing the QLF that indicated the patient’s Q-angle. When the trochlear groove was lateral or medial relative to the QLF, the angle is denoted + or −, and the femoral component included or excluded the patient’s Q-angle, respectively. Software measured the lateral undercoverage of the anterior femoral resection on a Computed Tomography (CT) scan, and the patella tilt angle (PTA) on a skyline radiograph. Complications, knee extension and flexion measurements, Oxford Knee Score, KOOS Jr, and Forgotten Joint Score were recorded pre- and post-operatively (at 6 weeks). A paired Student’s T-test determined the difference between the KA TKAs with a KAd-FC and MAd-FC with a significance set at p < 0.05. Results: The final analysis included thirty-five patients. The 20.5° trochlear groove of the KAd-FC was lateral to the QLF in 100% (15 ± 3°) of TKAs, which was greater than the 69% (1 ± 3°) lateral to the QLF with the 6° trochlear groove of the MAd-FC (p < 0.001). The KAd-FC’s 2 ± 1.9 mm lateral undercoverage of the anterior femoral resection was less than the 4.4 ± 1.5 mm for the MAd-FC (p < 0.001). The PTA, complication rate, knee extension and flexion, and clinical outcome measures did not differ between component designs. Conclusions: The KA TKA with a KAd-FC resulted in a trochlear groove lateral to the QLF that included the Q-angle in all patients, and negligible lateral undercoverage of the anterior femoral resection. These newly described radiographic parameters could be helpful when investigating femoral components designed for KA with the intent of promoting patellofemoral kinematics.

Is sequential bilateral robotic total knee arthroplasty a safe procedure? A matched comparative pilot study.

To our knowledge, no papers have reported the results of robotic-assisted surgery for sequential bilateral Total Knee Arthroplasty (TKA). Indeed, sequential bilateral TKA present several benefits, as one single anesthesia, surgical episode, hospitalization, and rehabilitation. The purpose of our study was to evaluate peri-operative outcomes and compare the complication rates, clinical outcomes, and implant positioning of sequential bilateral TKA performed with a robotic-assisted system versus a conventional technique. All patients who underwent a sequential bilateral robotic-assisted primary TKA (raTKA) in our institution between November 2019 and February 2021 were included. Twenty patients met the inclusion criteria and were matched with 20 sequential bilateral TKA performed with a conventional technique. The two groups were comparable for the demographic data and the preoperative parameters, including preoperative anticoagulation and ASA score. The minimum follow-up was 6 months. The operative time was significantly longer in the robotic group (< 0.0001), with a mean additional time of 29min. There was no significant difference between both groups for postoperative blood loss, rate of blood transfusion, or postoperative pain. The average length of stay was 5 days. There was one early complication in the robotic group due to the tibial trackers. The functional outcomes were similar between both groups, except for the functional KSS score, which was better at 6 months in the robotic group (p < 0.0001). The restoration of the knee alignment and the distal femoral anatomy were significantly better in the robotic group than in the conventional group. Despite a longer operative time, the peri-operative parameters of sequential bilateral TKA were similar between robotic and conventional techniques. Further, sequential bilateral raTKA was at least as safe as a conventional technique, without additional risk of medical complications.

Retrospective immediate post-operative comparative study of sequential bilateral total knee replacement versus unilateral total knee replacement for knee primary osteoarthritis

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The study is to compare the immediate post operative outcomes of sequential bilateral versus unilateral total knee replacement (TKR) for the treatment of primary knee osteoarthritis. Study comprised of 96 cases of tricompartmental knee primary osteoarthritis who have undergone unilateral and sequential bilateral total knee arthroplasty at Manipal Hospital, Goa from January 2016 to December 2018. The observations for each group was analysed and duration of hospital stay, post operative mobilisation, fall in haemoglobin level immediate post operative, need for blood transfusion, post operative complications, post operative pain and duration of surgery was recorded. The results were statistically compared. The mean duration of hospital stay, post operative blood loss in terms of fall in HB, post operative pain control, need of transfusions and duration of surgery revealed statistically significant differences.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Total 96 patients diagnosed with primary tricompartmental osteoarthritis were divided into two groups retrospectively. Group 1 operated with sequential bilateral TKR under single anaesthetic procedure and group 2 with unilateral TKR both operated by same surgeon and anaesthetist.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results: &lt;/strong&gt;It was observed that longer duration of surgery and hospital stay, higher fall in HB levels, increased need of analgesics and higher requirement of blood transfusions were associated with group 1 as compared to 2. Complication rates and post op mobilisation was similar in both groups.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Sequential bilateral TKR is a viable option for patient with symptomatic bilateral knees but patient selection and pre op counselling takes the priority. &lt;/p&gt;&lt;p class="abstract"&gt; &lt;/p&gt;

Safety of one-stage bilateral total knee arthroplasty-one surgeon sequential vs. two surgeons simultaneous: a randomized controlled study.

This study aimed to examinethe complications by comparing two surgeons simultaneous bilateral total knee arthroplasty (two-surgeon bilateral TKA) to one surgeon sequential bilateral total knee arthroplasty (single-surgeon bilateral TKA). Two hundred forty-six participants were prospectively randomized into two groups: two-surgeon bilateral TKA and single-surgeon bilateral TKA. While two surgeons performed simultaneous total knee arthroplasty in the two-surgeon bilateral TKA group, one surgeon performed sequentially in the single-surgeon bilateral TKA group. Ninety-day major, and minor complications rate, operative time, estimated blood loss (EBL) and patient-reported outcome measures were analysed. The two surgeons operated in two-surgeon bilateral TKA group 246 knees in 123 patients, while the single surgeon operated in single-surgeon bilateral TKA group 246 knees of 123 patients. The median operating time was 120 (range 70-151) minutes in the two-surgeon bilateral TKA group and 140 (range 75-190) minutes in the single-surgeon bilateral TKA group (p< 0.001). The median EBL was higher in the two-surgeon bilateral TKA group (p< 0.001). The 90-day complications were two major complications (1.6%) in the two-surgeon bilateral TKA group and 11 (8.9%) in the single-surgeon bilateral TKA group (p= 0.01). Two-surgeon simultaneous bilateral TKA is a safe method with lower complication rates compared with single-surgeon sequential bilateral TKA and can be preferred for experienced teams. However, peri- and post-operative care is required to decrease the risk of bleeding, particularly in patients undergoing two-surgeon simultaneous bilateral TKA. This study was retrospectively registered in a public trials registry ( https://clinicaltrials.gov/ , NCT04299516).

Should Sequential Bilateral Total Knee Arthroplasty Be Limited to Patients Younger than 80? A Two-Arm Propensity Matched Study

Despite multiple studies, there remains a debate on the safety of bilateral total knee arthroplasty (BTKA) in the average age patient, with a paucity of data on the outcome of BTKA in an elderly population. This study included 89 patients aged 80 years and older undergoing sequential BTKA over 14 years were identified in a prospectively collected database. Two matched comparison groups were created: patients under 80 undergoing sequential BTKA and patients over 80 undergoing unilateral TKA (UTKA). An analysis of complications, mortality, revision, and patient-reported outcome measures was performed. Mean age of the elderly cohorts was similar: 82.6 for BTKA and 82.9 for UTKA. The average age BTKA cohort had a mean age of 69.1. Complication rates were higher in bilateral cohorts, more so in the elderly BTKA cohort. Pulmonary embolism (PE) was observed in bilateral cohorts only. In these patients, history of PE and ischemic heart disease was a strong predictive factor for developing a major complication. There was no difference in revision rates and infection rates between the three cohorts, and no difference in patient survivorship between the two elderly cohorts. Through the combination of low revision and high survivorship rates and comparable clinical outcomes, this article demonstrates that simultaneous BTKA is an appropriate option to consider for an elderly patient, with proper patient selection and perioperative management. The demonstrated risk groups show that emphasis on patient selection should be focused on medical history rather than chronological age.

One-Surgeon vs Two-Surgeon Single-Anesthetic Bilateral Total Knee Arthroplasty: Revision and Mortality Rates From the Australian Orthopedic Association National Joint Replacement Registry

BackgroundOutcomes following 1-surgeon single-anesthetic sequential bilateral total knee arthroplasty (seq-BTKA) compared to 2-surgeon single-anesthetic simultaneous bilateral total knee arthroplasty (sim-BTKA) are largely unknown. The current study compared revision rates and all-cause mortality following seq-BTKA vs sim-BTKA using data from the Australian Orthopedic Association National Joint Replacement Registry. MethodsSeq-BTKA and sim-BTKA procedures recorded within the registry between September 1, 1999 and December 31, 2018 were analyzed for subsequent revision and patient mortality. Cumulative percent revision and cumulative percent survival were determined using the Kaplan-Meier method. Revision and mortality rates for sim-BTKA and seq-BTKA were compared using Cox proportional hazards models, adjusting for age and gender. ResultsIncluded in the analysis were 27,480 seq-BTKAs and 471 sim-BTKAs. There was no difference in the cumulative percent revision between the 2 groups (hazard ratio 1.23, 95% confidence interval 0.82-1.85). Cumulative percent patient survival was not significantly different between the 2 groups (hazard ratio 1.20, 95% confidence interval 0.93-1.54). ConclusionRevision rates and mortality were similar for seq-BTKA and sim-BTKA. Investigation of additional outcomes such as complications not requiring revision, pain, function, and cost is required to comprehensively understand the relative merits of each procedure.

Computer navigation has no beneficial effect on blood loss and transfusion in sequential bilateral total knee Arthroplasty.

Bilateral total knee arthroplasty is associated with significant blood loss. Postoperative anaemia retards patients recovery, and blood transfusion increases the risk for major complications including infection. While strategies like hypotensive anaesthesia, tranexamic acid, bone wax and so on are useful to conserve blood, navigation has also shown to decrease blood loss and transfusion in unilateral knee arthroplasty. The aim of this study was to compare the blood loss and transfusion in sequential bilateral knee arthroplasty performed with or without navigation. A retrospective case control cohort study of sequential bilateral knee arthroplasties was performed between 2 groups of 77 patients each, group N operated with navigation and group M operated without navigation. Both groups were matched for age, sex and body mass index. All patients were operated with similar surgical technique. The two cohorts were compared for blood loss calculated by three reliable methods. The preoperative haemoglobin (Hb) in group N was 12.83 ± 1.32 and group M was 12.58 ± 1.33 ( p = 0.24). The postoperative Hb taken day 4 before any blood transfusions was 8.60 ± 1.24 in group N and 8.54 ± 1.16 in group M ( p = 0.75). The average fall in Hb was 4.23 ± 1.08 in group N and 4.04 ± 1.19 in group M ( p = 0.31). There was no difference in blood loss between group N and M in all three methods; Gross equation ( p = 0.56), Hb dilution ( p = 0.24) and Hb balance ( p = 0.20). Need for blood transfusion was similar in group N and M ( p = 0.56). Blood loss and transfusion are equivalent in sequential bilateral total knee arthroplasty perform with or without navigation.

Impact of surgeon’s hand and ocular dominance on right and left total knee arthroplasty alignment

Postoperative alignment is an important modifiable confounder that contributes to the longevity of total knee arthroplasty (TKA). Studies have shown that surgeon’s handedness can affect surgical performance; however, no studies have assessed the effect of surgeon’s hand or ocular dominance on TKA alignment. The purpose of this study was to evaluate the effect of surgeon’s hand and ocular dominance on coronal plane alignment in TKA.&#x0D; We retrospectively evaluated 138 patients who underwent sequential bilateral TKA by the same surgeon, using the Genesis II PS knee (Smith &amp; Nephew, Memphis, TN). We assessed postoperative alignment by measuring and comparing anatomical tibiofemoral angle (TFA) bilaterally on standard postoperative knee radiographs, as well as Knee Society function and pain scores to determine any functional differences. Lastly, we evaluated whether a crossed hand-ocular dominant surgeon had greater accuracy when performing a TKA on the side opposite their hand dominance compared to uncrossed hand-ocular dominant surgeons.&#x0D; All surgeons were right-hand dominant and there was a significantly larger anatomical TFA on left TKAs (mean [SD], 4.6° [2.8°]) compared to right TKAs (3.8° [2.5°]) (P = 0.003). There was no significant difference between right and left Knee Society function (P = 0.09) and pain scores (P = 0.86). When comparing left TKAs, surgeons with uncrossed hand-ocular dominance (4.5°) performed with equal accuracy compared to surgeons with crossed hand-ocular dominance (4.8°) (2-tailed test = 0.597), indicating no effect of ocular dominance.&#x0D; In summary, hand but not ocular dominance was shown to have significant postoperative alignment effects on TKA.

Patellar tendon length during knee flexion of meniscal-bearing and rotating total knee arthroplasty implants.

The length of the patellar tendon after total knee arthroplasty (TKA) has most commonly been compared with preoperative measurements. However, there are no reports that discuss changes in the length of the patellar tendon during knee flexion after TKA. The purpose of this study was to evaluate changes in the length of the patellar tendon during knee flexion and to clarify the impact of changes in patellar tendon strain on the length of the patellar tendon and post-operative range of motion (ROM) after TKA. Thirty-six patients undergoing sequential bilateral TKA for osteoarthritis were evaluated. Patients received a meniscal-bearing (MB) implant on one side and a rotating platform (RP) implant on the other and were followed for a median of 115months (range 60-211months). The lengths of the patellar tendon at maximum extension, 30°, 60°, 90° and maximum flexion were measured, and the post-operative ROM of both knees were assessed. The effects of implant design and the knee flexion angle on the length of the patellar tendon were analysed using a linear mixed-effects model. The relationship between patellar tendon strain and post-operative knee ROM was assessed using Pearson's correlation coefficients. Post-operative clinical scores were similar for MB and RP implants. Neither the implant design nor the knee flexion angle significantly affected the length of the patellar tendon. The ROMs in the two designs at final follow-up were equivocal (114° in MB, 113° in RP). There was no correlation between patellar tendon strain and ROM in knees with either implant type. Patellar tendon lengths after mobile-bearing TKA with implants that permitted different anteroposterior constraints were relatively constant at varying degrees of knee flexion. Differences in patellar tendon strain may not impact ROM. These results provide conclusive evidence that the quality of the patellar tendon may play a less important role in ROM after TKA. Therapeutic study, Level II.

Levobupivacaine vs racemic bupivacaine in spinal anesthesia for sequential bilateral total knee arthroplasty: a retrospective cohort study

Study objectivesTo compare the anesthetic potency and safety of spinal anesthesia with higher dosages of levobupivacaine and bupivacaine in patients for bilateral sequential for total knee arthroplasty (TKA). DesignRetrospective cohort study. SettingOperation theater with postoperative inpatient follow-up. PatientsThe medical records of 315 patients who underwent sequential bilateral TKA were reviewed. InterventionsPatients who received intrathecal levobupicavaine 0.5% were compared with patients who received hyperbaric bupivacaine 0.5% with fentanyl 25 μg for spinal anesthesia. MeasurementsThe primary outcome was the use of rescue analgesia (systemic opioids, conversion to general anesthesia) during surgery for both groups. Secondary outcomes included adverse effects of local anesthetics (hypotension and bradycardia) during surgery and morbidity related to spinal anesthesia (postoperative nausea, vomiting, and bleeding) during hospital stay. Main resultsOne hundred fifty patients who received intrathecal levobupivacaine 0.5% (group L) were compared with 90 patients given hyperbaric bupivacaine 0.5% with fentanyl 25 μg (group B). The mean volume of levobupivacaine administered was 5.8 mL (range, 5.0-6.0 mL), and that of bupivacaine was 3.8 mL (range, 3.5-4.0 mL). Both groups achieved similar maximal sensory level of block (T6). The time to maximal height of sensory block was significantly shorter in group B than group L, 18.2 ± 4.5 vs 23.9 ± 3.8 minutes (P< .001). The time to motor block of Bromage 3 was also shorter in group B (8.7 ± 4.1 minutes) than group L (16.0 ± 4.5 minutes) (P< .001). Patients in group B required more anesthetic supplement than group L (P< .001). Hypotension and postoperative bleeding were significantly less common in group L than group B. ConclusionLevobupivacaine at a higher dosage provided longer duration of spinal anesthesia with better safety profile in sequential bilateral TKA.

Gait parameters in women with bilateral osteoarthritis after unilateral versus sequential bilateral total knee arthroplasty.

To compare gait parameters in women after unilateral total knee arthroplasty (TKA) versus sequential bilateral TKA to determine the need for sequential TKA. 35 women aged 60 to 74 (mean, 70) years with bilateral varus knee osteoarthritis (OA) underwent unilateral (n=23) or sequential bilateral (n=12) TKA by a single surgeon. All patients underwent unilateral TKA; 12 patients then underwent sequential TKA after 3 to 6 months of the first TKA. Gait parameters (step length, step width, gait velocity, single support phase value, and the maximum centre of gravity ratio) were compared before and after TKA, and between patients with unilateral versus bilateral TKA. Patients with sequential bilateral TKA had more severe OA in their contralateral knee than patients with unilateral TKA. In patients with unilateral and sequential bilateral TKA respectively, the mean step width differed at postoperative one month (12.9 vs. 19.1, p<0.01) and 3 months (11.9 vs. 16, p=0.03), and the mean maximum centre of gravity ratio differed at postoperative 3 months (2.43 vs. 1.75, p=0.02), whereas the mean step length, mean gait velocity, and mean single support phase values did not differ significantly between groups. After unilateral TKA, contralateral TKA may not be necessary in some patients whose gait has improved.

Perioperative Risk Assessment in Patients Aged 75 Years or Older: Comparison between Bilateral and Unilateral Total Knee Arthroplasty.

PurposeThe purpose of this study is to evaluate the risk of sequential bilateral total knee arthroplasty (TKA) under 1 anesthesia in patients 75 years or older.Materials and MethodsPatients aged 75 years or older who underwent sequential bilateral TKA (bilateral group, n=159) and unilateral TKA (unilateral group, n=159) between 2002 and 2012 were selected. All patients were evaluated for underlying medical diseases, such as cardiac, pulmonary, and renal problems, and high-risk patients were recommended to postpone the surgery. We compared the underlying diseases, major postoperative complications, and the length of hospital stay between bilateral and unilateral groups.ResultsThe prevalence of underlying diseases of the bilateral group was 74.8% and major complications occurred in 6 patients (3.8%). The prevalence of underlying diseases of the unilateral group was 52.4% and complications were observed in 4 patients (2.4%). Although the complication rate of the bilateral group was slightly higher than that of the unilateral group, the difference was not statistically meaningful (p=0.204). The length of hospital stay was 21.9 days for the bilateral group and 24.9 days for the unilateral group.ConclusionsThere was no significant difference in postoperative complications between groups. The result shows that bilateral TKA can be relatively safe compared with unilateral TKA in patients 75 years or older. However, careful selection of low-risk patients is advised.

Comment on "comparison of The major intraoperative and Postoperative complications Between unilateral and Sequential bilateral total knee Arthroplasty in a high-volume Community hospital"

It was with great interest that we read the recent article by Spicer, Thomas and Rumble,1 which provides an insight into the safety of unilateral total knee arthroplasty (UTKA) versus sequential or simultaneous bilateral total knee arthroplasty (BTKA) in a high-volume community hospital. The authors excluded from their study patients who underwent staged TKA, defined as “2 distinct surgeries on both knees within a 1-year period.” Instead, candidates with bilateral knee symptoms who were deemed eligible for surgery were given the option of BTKA or 2 UTKAs.1 In our experience with patients who present with bilateral fixed flexion knee deformities, even if a UKTA is initially successful, it may develop stiffness and adopt the fixed flexion of the contralateral knee if the latter is not likewise replaced within a few months. Residual flexion contractures after knee replacement have been associated with poor outcomes.2 The limitation of movement and impact on quality of life caused by a residual flexion contracture3 should be considered a complication in itself. This complication might be avoided by performing a BTKA or careful pre- and postoperative management to safely complete staged TKA procedures in considerably less than 1 year. Although it seems reasonable that “individuals who decline the second operation may have been better served by a 1-step BTKA,”1 the alternative is perhaps more relevant to orthopedic departments where there is less experience and expertise in performing BTKAs. The merits of BTKA versus staged TKA have been extensively discussed in the literature. Reduced costs, single anesthetic and decreased total recovery time have been highlighted as advantages of BTKA,4 but an increased risk of serious postoperative complications have also been reported.5 We hope that future studies will continue to objectively evaluate the risks and benefits of each, and identify which patients might be more suited to a particular method.

Comment on "comparison of The major intraoperative and Postoperative complications Between unilateral and Sequential bilateral total knee Arthroplasty in a high-volume Community hospital"; The Authors Respond

Comment on "comparison of The major intraoperative and Postoperative complications Between unilateral and Sequential bilateral total knee Arthroplasty in a high-volume Community hospital"; The Authors Respond

Comparison of the major intraoperative and postoperative complications between unilateral and sequential bilateral total knee arthroplasty in a high-volume community hospital

Total knee arthroplasty (TKA) is a common surgical treatment for arthritis. In the event of bilateral knee symptoms, a patient may elect for bilateral TKA (BTKA) under 1 anesthetic or 2 separate unilateral TKAs (UTKA). Controversy exists in the literature regarding the safety of BTKA versus UTKA. We compared the rate of major intraoperative and postoperative complications for BTKA versus UTKA at a high-volume community hospital. We compared 373 patients who underwent BTKA with 966 who underwent UTKA between May 2008 and May 2011. Health records were used to determine patient characteristics and major intraoperative and postoperative complications. The BTKA and UTKA cohorts were matched for demographic characteristics and comorbidities with the exception of previous transient ischemic attack and previous knee surgery (UTKA > BTKA). Rates of intraoperative and postoperative complications, including cardiovascular, thromboembolic and neurologic complications; deep wound infections; and mortality, did not differ significantly between groups. Bilateral TKA was associated with a greater proportion of patients requiring blood transfusion than UTKA (29.8% v. 8.9%, p < 0.001). Among those transfused, there was no significant difference between the groups in the mean number of units required (1.72 ± 0.77 v. 1.53 ± 0.85 units, p = 0.68). Bilateral TKA was not associated with statistically greater rates of intraoperative and postoperative complications than UTKA, barring the proportion of patients requiring transfusion. Our results support the use of BTKA to treat bilateral knee arthritis in a high-volume community hospital setting.

Influence of bilateral sequential total knee arthroplasty on functional recovery

Background:Main concerns of patients undergoing bilateral surgery is the quantum of pain and the progress of functional recovery. We studied functional recovery in terms of pain, range of motion (ROM), SF12, WOMAC scores and a unique TUG (timed up and go) test for patients undergoing unilateral total knee arthroplasty (U/L-TKA) and sequential bilateral total knee arthroplasty (B/L-TKA).Materials and Methods:Three groups of 77 consecutive patients (91 knees) were retrospectively compared. They were B/L TKA group (28 knees: 14 patients), Unilateral TKA group with contralateral knee nonoperated i.e., U/L-TKA group (42 knees) and Unilateral TKA with contralateral TKA already done i.e., U/L + C/L TKA group (21 knees). Patients were assessed preoperatively and on postoperative days 3, 5, 14, 42, 90 and 1 year.Results:The WOMAC score was statistically better preoperatively in the U/L + C/L TKA group, and SF12 MCS score was statistically better preoperatively in the B/L-TKA group. The TUG test time in the B/L-TKA group was statistically longer on days 3 and 5 as compared to other groups and became comparable by day 14. The TUG score became better than the preoperative value by day 42 in the B/L-TKA group, which took 90 days in other groups.Conclusion:The early functional recovery of bilateral TKA patient lags behind that of unilateral TKA patient for the first 5 days, becomes equal by the 14th day and remains equal till 1 year after surgery. Bilateral TKA patients regain their preoperative functional status by 6 weeks against 3 months for unilateral TKA. The operative status of the contralateral knee makes no difference to early functional recovery after unilateral TKA. With bilateral TKA, there is no difference in pain and ROM parameters.

Evaluation of Total Knee Arthroplasty Performed With and Without Computer Navigation: A Bilateral Total Knee Arthroplasty Study

Sequential bilateral total knee arthroplasty performed on 54 patients utilizing navigation (CAS-TKA) in one knee and traditional instrumentation (T-TKA) in the contralateral knee was reviewed at a mean follow-up duration of 2.5years. There were no differences with regard to KSS, ROM, postoperative anatomic alignment, mechanical axis, or tibial angle. There was a statistically significant decrease in outliers for the CAS-TKA group with respect to anatomic alignment (3.7% vs. 17.0%, P=0.024), mechanical axis (6.1 vs. 20.4%, P=0.037) and tibial component alignment (0% vs. 7.5%, P=0.042). There is no apparent benefit of CAS-TKA with regards to KSS, ROM, or alignment in the hands of fellowship-trained total joint specialists. The clinical relevance of reduced outliers in the CAS-TKA group is unknown with the current follow-up interval.

The effect of postoperative pain on postoperative blood loss after sequential bilateral total knee arthroplasty

BackgroundBilateral total knee arthroplasty is generally accompanied by a significant amount of blood loss. We investigated the relationship between the intensity of pain and the amount of blood loss in the early postoperative period after bilateral total knee arthroplasty.MethodsA prospective study was conducted on 91 patients who underwent elective sequential bilateral total knee arthroplasty for osteoarthritis. All patients received combined spinal and epidural anesthesia. Patients were divided into three groups based on their scores on the verbal numerical rating scale (VNRS) for pain at 6 hours postoperatively. The VNRS was classified as follows; mild pain (n = 34, VNRS score 0-4), moderate pain (n = 24, VNRS score 5-6), and severe pain (n = 33, VNRS score 7-10). We compared the mean arterial pressures and the amount of blood loss during the first 24 postoperative hours in the three groups. Factors influencing postoperative blood loss were analyzed.ResultsPostoperative mean arterial pressures and blood loss were not different among the groups. Of the factors examined, the amount of postoperative blood loss was only dependent on the amount of intraoperative blood loss (P = 0.001).ConclusionsEarly postoperative pain has no effect on postoperative blood pressure and the amount of blood loss after bilateral total knee arthroplasty. For postoperative blood loss, intraoperative blood loss is the main determinant.

An Autotransfusion Device Reduces the Amount of Allogenic Transfusion in Bilateral Sequential Total Knee Arthroplasty

Purpose: This study examined the difference in the reduction of the amount of required allogenic transfusion after bilateral total knee arthroplasty when an autotransfusion device was used. Materials and Methods: The subjects were ninety five patients who underwent sequential bilateral total knee arthroplasty from January 2006 to May 2010 by one surgeon. The first group was 50 patients who did not have an autotransfusion device used and second group of 45 patients were those who had an autotransfusion device used during the postoperative period. Group 1 received allogenic blood transfusion with a standard level of postoperative hemoglobin. The group 2 patients were reinfused with as much blood as was collected by an autotransfusion suction bag and then they received allogenic blood transfusion with a standard level of postoperative hemoglobin. Results: The total blood loss and amount of blood transfusion were almost the same in the two groups. The mean amount of allotransfusion was 1,270.0 mL in group 1 and 564.4 mL in group 2 and the reduced amount of allotransfusion in group 2 was statistically significant (p＜0.05). Conclusion: Using an autotransfusion device is a good method to reduce the mean amount of allotransfusion after bilateral sequential total knee arthroplasty.