Simultaneous Bilateral Total Knee Replacement Research Articles

Complications in simultaneous bilateral total knee arthroplasty, is it a safe procedure?

BackgroundThere is controversy regarding various aspects of simultaneous bilateral total knee replacement (SBTKR). We found disparity in the postoperative outcomes and complications associated with the procedure in the literature linked with the topic. ObjectiveTo retrospectively analyze the need for blood transfusion after surgery and complications associated with total knee replacement according to the type of procedure (SBTKR or unilateral). MethodsRetrospective cohort analytical study. We included 251 patients with severe knee osteoarthritis that were divided into two groups. 124 (49%) who underwent SBTKR and 127 upon whom unilateral total knee replacement (UTKR) was performed. Demographic data, days of hospitalization, complications within the first 90 days after surgery (thromboembolic events, superficial and deep infection, stiffness, death); and percentages of patients transfused with blood products during hospitalization were evaluated. ResultsThere were no statistical differences in the analysis of postoperative complications in the first 90 days after surgery. In the SBTKR group, 8 patients (6.5%) presented some thromboembolic complication during the postoperative period, while this event was observed in only 2 patients (1.5%) from the other group. The analysis showed a statistically significant drop in postoperative hemoglobin, on average that of 0.8 ​g/dl, in the SBTKR patient group compared to the UTKR group (95% CI 0.44–1.13; p ​< ​0.001). A higher proportion of patients who required transfusion were observed in the SBTKR group (40%) (OR ​= ​7.12; 95% CI 3.3–16; p ​< ​0.001).We analyzed the cause of postoperative transfusion in the patients who required transfusion taking into account two parameters: hemoglobin less than 8 ​g/dl and the clinical needs of the patients (symptoms of hypotension, decay, difficulty to rehabilitate without pain, dyspnea). 59 patients received transfusion (50 in the SBTKR group and 9 in the other group). Of these, 19 patients (32.2%) did not meet any transfusion criteria. ConclusionWe consider SBTKR a safe procedure, which does not increase postoperative complications compared to UTKR. Although there is an increase in blood loss in SBTKR, it does not generate clinical symptoms of relevance. Level of evidenceLevel III.

Clinical outcomes of simultaneous bilateral total knee arthroplasty.: A tertiary-center experience.

ABSTRACTObjectives:To characterize patients who underwent simultaneous bilateral total knee arthroplasty (simBTKA) and study the outcomes of surgery along with complication rates.Methods:This is a retrospective study carried out at King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia. The study included patients who had undergone simultaneous bilateral total knee replacement from January 2010 until June 2021.Results:The median age of our patients was 64 (Q1-Q3: 59-70) years, 76 (13.2%) males and 393 (83.8%) were females. Hypertension was the most common associated comorbidity (56.29%) and primary osteoarthritis was the most common indication of surgery (96.8%). The median duration of surgery was 155 (140-175) minutes and the median duration of hospital stay was 9 (8-11) days. A total of 17 (3.62%) patients needed revision of surgery in a median duration of 265 (112-529) days. The composite endpoint of complications, intensive care unit admission, and blood transfusion occurred in 132 (28.14%) patients. Hospital stay was longer in males (coefficient: 0.11 [0.02-0.19]; p=0.01) and in patients with cardiac (coefficient: 0.12 [0.02-0.21]; p=0.02), and renal diseases (coefficient: 0.23 (0.06-0.39); p=0.01). Cardiac disease was the only factor associated with the composite outcome (odds ratio: 2.25 [1.19-4.24]; p=0.01).Conclusion:Our results suggest simBTKA is a safe procedure with a low complication rate. However, male patients and those with cardiac and renal diseases are at increased risk of post-operative complications and prolonged hospital stay.

Comparison of Frequency and Morbidity of Unilateral Total Knee Replacement Versus Simultaneous Bilateral Total Knee Replacement.

IntroductionTotal knee replacement (TKR) is a procedure that is often performed on patients who have advanced osteoarthritis and has become more common. Bilateral TKR can be done at the same time and can save time, anesthesia and cost of multiple procedures.ObjectiveTo determine the frequency of unilateral and simultaneous bilateral total knee replacement and then compare their outcomes.MethodsA total of 95 patients were included and were divided into two groups, i.e., patients undergoing unilateral TKR were grouped as group A and patients undergoing bilateral TKR were grouped as group B. Then patients underwent surgery under general anesthesia. All patients were followed up in the outpatient department (OPD). During follow-up, patients were evaluated for the outcome, i.e., cardiac event, urinary tract infection and surgical site infection. All this information was recorded on proforma while analyzed in SPSS v. 22 (IBM Corp., Armonk, NY). The outcome was compared in both groups by using chi-square test. The P-value ≤ 0.05 was considered as significant.ResultsThe mean age of patients was 63.00 ± 6.17 years. There were 50 (52.6%) males and 45 (47.4%) females. The mean BMI of females was 27.93 ± 2.43 kg/m2. There were 47 (49.5%) patients who underwent simultaneous bilateral surgery while 48 (50.5%) underwent unilateral surgery. It has been observed that after surgery, the cardiac event occurred in one (1.1%) case and that case was from unilateral surgery group; urinary tract infection occurred in four cases, two (4.3%) were from bilateral cases while two (4.2%) were from the unilateral group and surgical site infection occurred in four cases, two (4.3%) were from bilateral cases while two (4.2%) were from the unilateral group. The difference was insignificant in both groups (p>0.05).ConclusionThus, there was no significant difference observed between both groups regarding complications after surgery.

A study of cocktail injection: Pain control and knee motion recovery after total knee replacement

Pain control after total knee replacement (TKR) is pivotal in postoperative rehabilitation. Usage of epidural analgesia or parenteral opioids can cause undesirable side effects hampering early recovery and rehabilitation. These side effects can be avoided by infiltration of an analgesic cocktail locally. Our study was performed to evaluate the benefits of a particular cocktail combination in patients undergoing TKR with respect to pain and knee motion recovery. Fifty consecutive patients who underwent simultaneous bilateral TKR were enrolled and received an intraoperative periarticular cocktail injection in the right knee (intervention) and normal saline in the left knee (control). Postoperative pain was recorded using the visual analog scale for each knee, and the time taken to achieve 90 degree of knee flexion was noted for each side. The cocktail injected knee had significantly less pain when compared with the control knee during the first 2 days and significantly shorter period to achieve 90 degree of knee flexion. The use of intraoperative periarticular cocktail injection significantly reduces early postoperative pain and provides better early knee motion.

CRP (C Reactive Protein) level after total knee replacement in Indian population--- does it follow Anglo-Saxon trend?

BackgroundThis study was to determine how C-reactive protein (CRP) responds after total knee replacement (TKR), including both unilateral and simultaneous bilateral TKR in Indian population and if it follows Anglo-Saxon trend. Published literature from North America and Europe shows CRP value peaks on the 2nd post-operative day and drops to normal by 6–8 weeks. We started the study with null hypothesis.Material and methodsThis is a prospective study, with 50 patients (all females, 25 received unilateral operations and 25 bilateral ones) included. CRP levels were measured, on the 2nd day, 8, 12 and 16 weeks after operation.ResultsIn both groups, CRP level rose the 2nd post-operative day. The rise in CRP level was significantly higher in the simultaneous bilateral TKR group than in the unilateral TKR group. In unilateral cases, CRP on the 2nd postoperative day ranged from 65 to 110 mg/l with average level of 80 mg/ml. In bilateral TKR cases, CRP level on the 2nd postoperative day was between 110 and 180 mg/l with a mean of 140 mg/ml. The CRP level returned to normal in about 40% of unilateral TKR patients 8 weeks after operation, while in 92% (23 out of 25) of bilateral simultaneous TKR patients it stayed at a high level 8 weeks post-op and did not come back to normal. At 12 weeks CRP decreased to normal in all 100% of unilateral TKR patients and 32% of bilateral TKR patients. At 16 weeks, CRP was normal in all bilateral TKR patients.Conclusion60% of our unilateral TKR patients and 92% of our simultaneous bilateral TKR patients did not achieve a normal CRP 8 weeks after operation. These findings are significant as CRP is commonly used as a very sensitive indicator of postoperative joint infection. Hence we conclude that in the Indian TKR patients the CRP values take longer time to return to normal than in their Anglo-Saxon counterparts. Published results regarding the normal levels of CRP in unilateral TKR should not be extrapolated to simultaneous bilateral TKR patients.

Comparison of simultaneous bilateral versus unilateral total knee replacement on pain levels and functional recovery

BackgroundTotal knee replacement is a common operative procedure to improve pain, function, and quality of life in patients with end stage knee osteoarthritis. The current study aimed to compare simultaneous bilateral versus unilateral total knee replacement on pain intensity and recovery of function.MethodsA total of 80 patients (bilateral 50, unilateral 30) aged 63.28 (9.4) years undergone total knee replacement participated in the current study. The participants were admitted for 5–7 days in the hospital. Participants in both the group received similar inpatient and outpatient physiotherapy sessions. Pain intensity and function capacity were assessed at baseline, day 7, and day 30 postoperatively using visual analogue scale and lower extremity functional scale, respectively. Repeated measures analysis of variance was used to analyze the data.ResultsBoth groups showed a significant reduction of pain intensity (Day 0, mean 8.9, SD 1.0; Day 30, mean 2.2, SD 1.3 in bilateral total knee replacement; Day 0, mean 8.8, SD 1.1; Day 30, mean 2.0, SD 1.5 in unilateral total knee replacement; p < 0.001) and improvement in the functional capacity (Day 0, mean 16.2, SD 10.1; Day 30, mean 55.6, SD 14.6 in bilateral total knee replacement; Day 0, mean 19.1, SD 9.1; Day 30, mean 56.7, SD 15.8 in unilateral total knee replacement; p < 0.001) following total knee replacement at 30 days post-operatively. However, there was a non-significant difference noted between bilateral versus unilateral total knee replacement on the reduction of pain intensity (mean changes, 6.9 versus 6.8) and improvement in the functional capacity (mean changes, 39.4 versus 37.6) at 30 days post-operatively (p > 0.05).ConclusionSimultaneous bilateral total knee replacement was associated with a similar reduction of pain intensity and recovery of function compared to unilateral total knee replacement, suggesting the use of simultaneous bilateral total knee replacement in patients with bilateral knee osteoarthritis since its costs and rehabilitation process could be reduced compared to staged bilateral total knee replacement.

Clinical profile of patients undergoing bilateral total knee replacement at a tertiary care hospital

During standing, the joint reaction force increases with increasing knee flexion as the force vectors of quadriceps and patellar tendons become more parallel to the joint reaction force. It has been calculated, patella-femoral joint reaction forces is of 2-5 times body weight during activities of daily living; during squatting to 120 degree of knee flexion, the joint reaction force may be as high as 7-8 times body weight. During knee flexion, the patella makes a rolling or gliding motion along the femoral articulating surface. This study was conducted in Department of Orthopaedics, twenty patients who Consented (12 female and 8 male) and underwent SBTKR for tricompatrmental arthritis of knee using a posterior stabilized type of knee prosthesis, were assessed functionally using knee society score and oxford knee score. In the present study Knee society score and oxford scores were assessed in patients post operatively after simultaneous bilateral total knee replacement at 3 months, 6 months and 12 months. it was observed that the mean KSS score right knee improved from 132.9 at 3 months to 144.57 at 6 month and 159.86 at 12 months. Mean KSS score left knee improved from 133.7 at 3 months to 145.29 at 6 month and 161.1 at 12 months. Mean oxford score improved from 32.4 at 3 months to 36.76 at 6 month and 40.38 at 12 months.

Functional outcome of simultaneous bilateral total knee replacement (SBTKR): Prospective clinical study

Functional outcome of simultaneous bilateral total knee replacement (SBTKR): Prospective clinical study

Effectiveness of intraoperative periarticular cocktail injection for pain control and knee motion recovery after total knee replacement

BackgroundPain control after total knee replacement (TKR) is pivotal in postoperative rehabilitation. Usage of epidural analgesia or parenteral opioids can cause undesirable side effects hampering early recovery and rehabilitation. These side effects can be avoided by infiltration of an analgesic cocktail locally. Our study was performed to evaluate the benefits of a particular cocktail combination in patients undergoing TKR with respect to pain and knee motion recovery.MethodsOne hundred consecutive patients who underwent simultaneous bilateral TKR were enrolled and received an intraoperative periarticular cocktail injection in the right knee (intervention) and normal saline in the left knee (control). Postoperative pain was recorded using the visual analog scale for each knee, and the time taken to achieve 90° of knee flexion was noted for each side.ResultsThe cocktail injected knee had significantly less pain when compared with the control knee during the first 48 hours and significantly shorter period to achieve 90° of knee flexion.ConclusionsThe use of intraoperative periarticular cocktail injection significantly reduces early postoperative pain and provides better early knee motion.

Complications associated with staged versus simultaneous bilateral total knee arthroplasty: An analysis of 7747 patients

BackgroundBenefits of simultaneous bilateral total knee replacement (TKR) include lower costs, decreased hospital stay, and shorter rehabilitation. This study evaluated complications associated with simultaneous versus staged bilateral TKR within 12 months. We hypothesized that after controlling for comorbidities, the simultaneous group would have the highest rate of complications. MethodsThis retrospective study analyzed the Humana subset of the PearlDiver Patient Records Database. CPT 27447 and associated modifiers were used to identify patients who underwent simultaneous or staged bilateral primary TKRs. Staged bilateral TKRs were performed within 12 months and were stratified by the time between procedures. Primary outcomes were the Centers for Medicare & Medicaid Services' publicly reported complications. Risks of complications were compared using multivariate logistic regression controlling for age, gender, and comorbidities. ResultsSeven thousand seven hundred forty-seven patients underwent simultaneous or staged bilateral TKRs between January 2007 and April 2015. There were lower odds of transfusion and all-cause 90-day readmission but higher odds of mechanical complications and infection for all staged groups compared to the simultaneous. Patients whose staged surgeries were ≪3 months apart had significantly higher odds of undergoing manipulation under anesthesia (MUA). ConclusionsHigher rates of blood transfusion and readmission were associated with simultaneous bilateral TKR, while higher rates of mechanical complications and infection were associated with staged bilateral TKR. MUA risk was highest in patients staged ≪3 months apart. While there are inherent risks to simultaneous bilateral TKR, surgeons and patients should also be aware of risks associated with staging the procedures. Level of evidenceIII

No difference in the functional improvements between unilateral and bilateral total knee replacements

BackgroundDifferences between staged bilateral total knee replacement (TKR) and simultaneous bilateral TKR have been investigated, but few studies have investigated differences in the functional improvements resulting from these methods. Therefore, this study investigates the different functional improvements between staged bilateral total knee TKR and simultaneous bilateral TKR.MethodsAmong 144 potential bilateral TKR patients who were included in this study, 93 (64.6%) patients selected unilateral TKR and 51 (35.4%) selected bilateral TKR. Functional improvements were assessed using the Western Ontario and McMaster University osteoarthritis index (WOMAC) and the Medical Outcomes Trust Short Form-36 (SF-36), and patients were interviewed pre-operatively and after 6 months. A generalized equation was used to test for differences in functional improvements.ResultsAfter TKR, pain, stiffness, function and total WOMAC scores were significantly reduced in both groups, with mean changes from − 26.6 to − 41.4 and from − 27.5 to − 42.2.The mean health change of SF-36 scores, physical component and mental component scores changed to 45.2 ± 18.2, 74.0 ± 15.4 and 77.0 ± 9.6, respectively, in Group 1 and 47.1 ± 17.1, 74.0 ± 15.2 and 75.5 ± 12.1, respectively, in Group 2.Unilateral and simultaneous bilateral TKR produce similar functional improvements, although current work status may be a novel impact factor.ConclusionNo differences in functional improvements were identified between patients who selected unilateral versus bilateral TKR, indicating no recommendation for one procedure over the other.

Adductor canal block for post-operative analgesia after simultaneous bilateral total knee replacement: A randomised controlled trial to study the effect of addition of dexmedetomidine to ropivacaine.

Background and Aims:Knee replacement surgery causes tremendous post-operative pain and adductor canal block (ACB) is used for post-operative analgesia. This is a randomised, controlled, three-arm parallel group study using different doses of dexmedetomidine added to ropiavcaine for ACB.Methods:A total of 150 patients aged 18–75 years, scheduled for simultaneous bilateral total knee replacement, received ultrasound-guided ACB. They were randomised into three groups -Group A received ACB with plain ropivacaine; Groups B and C received ACB with ropivacaine and addition of dexmedetomidine 0.25 μg/kg and 0.50 μg/kg, respectively, on each side of ACB. The primary outcome was the duration of analgesia. Total opioid consumption, success of early ambulation, and level of patient satisfaction were also assessed.Results:The patient characteristics and block success rates were comparable in all groups. Group C patients had longer duration of analgesia (Group C 18.4 h ± 7.4; Group B 14.6 ± 7.1; Group A 10.8 ± 7; P < 0.001); lesser tramadol consumption (Group C 43.8 mg ± 53.2; Group B 76.4 ± 49.6; Group A 93.9 mg ± 58.3; P < 0.001) and lesser pain on movement (P < 0.001). The patients in Group B and C walked more steps than in Group A (P < 0.002). The level of patient satisfaction was highest in Group C (P < 0.001).Conclusions:The addition of dexmedetomidine to ropivacaine resulted in longer duration of analgesia after adductor canal block for simultaneous bilateral total knee replacement surgery.

Aerobic Capacity after Bilateral Total Knee Replacement Surgery

PURPOSE: The purpose of this case study was to analyze aerobic capacity during a walking treadmill test and a staircase walk before and after bilateral total knee replacement (TKR) surgery. METHODS: The patient was a 61-year-old male who underwent a simultaneous bilateral TKR procedure for advanced osteoarthritis and began physical therapy four days post-surgery. His physician classified his condition as “bone-on-bone” prior to the surgery. The patient performed outpatient rehabilitation three times per week for a total of thirteen sessions and then returned to normal activities of daily living. Aerobic capacity, including heart rate, minute ventilation, and oxygen consumption during submaximal exercise were assessed one day before surgery and 2, 4, 6, and 12 months post-surgery using COSMED K4b2 mobile metabolic analyzer. RESULTS: Heart rate and oxygen consumption were higher throughout the walking treadmill test before TKR surgery when compared to all four post-surgery time points. Maximum exercise heart rate during the treadmill test was 23.9% lower 2 months, 37% lower 4 months, 37.8% lower 6 months, and 43.7% lower 12 months post-surgery. Maximum exercise oxygen consumption was 24.2% lower 2 months, 31.2% lower 4 months, 39% lower 6 months, and 27.2% lower 12 months post-surgery. Interestingly, minute ventilation was similar before and after surgery. The time it took the patient to perform four passes on a three story staircase greatly improved over time post-surgery from 8 minutes 2 months post-surgery to 5 minutes 12 months post-surgery. CONCLUSION: The case study patient demonstrated major improvements in aerobic capacity following the cessation of physical therapy both on the treadmill and during a staircase walk following bilateral TKR surgery.

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

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.

Maximising early recovery by modified surgical approach: Randomized control prospective series of 50 patients treated with the standard medial parapatellar and mid-vastus surgical approaches

Background: The medial parapatellar approach is the workhorse of total knee replacement. Modified (mid-vastus and subvastus) approaches have been advocated to improve quadriceps power, improve knee flexion and provide better pain relief. However, detractors state difficulty in patella eversion and visualisation of the lateral tibial plateau as concerns. Does the mid-vastus approach really provide these purported advantages? We report an analysis of our prospective randomised controlled trial in 50 patients undergoing simultaneous bilateral total knee arthroplasty using a medial parapatellar approach in one knee and the mid-vastus approach in the other. Methods: 50 consecutive elderly patients with bilateral knee osteoarthritis underwent simultaneous bilateral total knee replacement (randomized to undergo standard medial parapatellar approach in one knee and mid-vastus approach in the other knee) from Dec 2012 to Mar 2013. Strict inclusion and exclusion criteria were followed and the two surgical approaches were randomised to the left or right knee. A blinded independent observer evaluated immediate and early post-operative clinical radiological criteria for each knee at 2 weeks, 6 weeks, 3 months and 12 months post-surgery. The collated results were then matched to the approach taken, and analysed for statistical differences. Results: The return of active straight leg raise, quadriceps power and function was statistically higher with the mid-vastus approach at 2 weeks, 3 months and 6 months, without any statistical difference at 12 months. Pain control was also better in the mid-vastus approached knee, though statistically not significant. All other intra-operative and post-operative parameters were the same at the points of evaluation. At 12 months, comparable criteria between the two groups were statistically insignificant. Discussion: The mid-vastus approach significantly reduces the immediate post-operative pain, and improves the quadriceps function and knee flexion. There is no difficulty in exposing the lateral tibial surface and/or implanting the tibial component. However, it needs to be reiterated that this benefit lasts for the first 3 months, and seems to provide no extra benefit in the mid- or long-term. This approach is recommended in patients with low BMI as one of the components for early recovery. It may significantly reduce the duration of hospital stay as well.

Effects of Systemic Disorders on Postoperative Complications After Simultaneous Bilateral Total Knee Replacement.

The aim of the present study was to retrospectively evaluate the association between accompanying systemic disorders and major complications developing in the early postoperative period in patients who underwent simultaneous bilateral total knee arthroplasty with combined spinal and epidural anaesthesia. In the present study, the medical records of a total of 456 patients were analyzed. Preoperative data, including the American Society of Anesthesiologists physical status and presence of coronary artery disease (CAD), chronic pulmonary disease, diabetes mellitus (DM), hypertension and renal insufficiency were recorded. Furthermore, the data related to major complications, such as cardiac complications, respiratory complications, acute myocardial infarction (AMI), thromboembolism, cerebrovascular accident (CVA), confusion, acute renal failure (ARF), shock and cardiopulmonary arrest were recorded. We found that the frequency of complications markedly increased in the presence of concurrent DM and hypertension, or DM, hypertension and CAD, or DM and CAD. Further, 0.2% of the patients developed AMI, 3.3% developed cardiac complications, 2.2% developed respiratory complications, 0.9% developed thromboembolism, 0.2% developed CVA, 2% developed confusion and 0.4% developed cardiac arrest and shock in the first week after the operation. The frequency of cardiac and pulmonary complications and confusion was higher in patients aged above 65 years compared to patients below 65 years. We observed that the frequency of cardiac and pulmonary complications and confusion in the early postoperative period was markedly higher in patients aged above 65 years and in patients with concurrent DM and cardiovascular comorbidities.

Reducing Blood Loss in Simultaneous Bilateral Total Knee Arthroplasty

Objectives:We asked whether tranexamic acid administration could reduce blood loss and blood transfusion requirements after simultaneous bilateral total knee arthroplasty (TKA). This study examined the role of different method of tranexamic acid administration in TKA.Methods:The study enrolled 81 patients who underwent simultaneous bilateral total knee replacement in a prospective, randomized, double-blind study. The patients who were randomized into the TXA group received both intravenous and intra-articular TXA. The control group did not receive TXA. The anesthetist, surgeon, and observer were blinded to the study group (double-blinded). TXA was administered as a bolus dose of 15 mg/kg 10 min before the inflation of the tourniquet on the first side. This was followed by continued intra-articular administration of 3 g at 10 min before the deflation of the tourniquet. Intravenous infusion of 10 mg/kg/h was continued for the next 3 h. Equal volumes of placebo were administered at the same rate and by the same route. We measured volume of drained blood 48 hours postoperatively, decrease in hemoglobin levels 12 hours postoperatively, amount of blood transfused, and number of patients requiring allogenic blood transfusion (BT).Results:Mean (± SD) postoperative volume of drained blood was lower in the group receiving tranexamic acid (509.39 ± 224.97mL) than in control subjects (961.37 ± 427.99mL). The mean hemoglobin decrease 12 hours postoperatively was lower in patients receiving tranexamic acid (2.07 ± 1.11g/dL) than in control subjects (3.21 ± 1.05g/dL). The amount of blood transfused and number of patients requiring blood transfusion were lower in patients receiving tranexamic acid than in control subjects.Conclusion:This prospective randomized study showed that during simultaneous bilateral TKA, TXA reduced blood loss and helped to reduce the BT amount and frequency with negligible side effects. With regard to the administration route, combined intravenous–intra-articular administration of TXA significantly reduces blood loss and the need for BT associated with bilateral simultaneous total knee replacement without enhancing the risk of deep vein thrombosis.

The effects of systemic disorders on postoperative complications after simultaneous bilateral total knee replacement

The effects of systemic disorders on postoperative complications after simultaneous bilateral total knee replacement

An atypical presentation of acute pancreatitis after simultaneous bilateral total knee replacement: A case report

Acute pancreatitis is a known post-operative complication, commonly after abdominal surgery rather than total knee arthroplasty. When complications occur, post total knee arthroplasty, they tend to be cardiovascular and neurological events, rarely involving the gastrointestinal system. Therefore, when gastrointestinal complications occur, especially if they present with atypical symptoms, this tends to result in a delay in diagnosis. We present a case of acute pancreatitis post simultaneous bilateral total knee arthroplasty in a patient with risk factors like alcoholism and hypercholesterolaemia. Its atypical presentation of only persistent tachycardia, without abdominal pain, was misleading and the resultant delay in treatment dangerous. Therefore, it is important to consider acute pancreatitis as a differential diagnosis in a patient with persistent tachycardia post total knee arthroplasty, especially if he has risk factors for the condition.

Simultaneous Bilateral Total Knee Replacement: A Prospective Study of 150 Patients

To evaluate the safety of simultaneous bilateral total knee replacement (TKR). 124 women and 26 men (mean age, 66 years) underwent simultaneous bilateral TKR for tricompartmental osteoarthritis using a posteriorstabilised, high-flexion implant. All patients underwent dobutamine stress echocardiography for detection of any silent cardiac comorbidity by a cardiologist. None had any adverse effect after testing. Five patients had positive outcome and underwent coronary angiography to detect any significant coronary blockage. Functional outcome was evaluated using the Knee Society Score (KSS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC). Tranexamic acid was given intravenously to reduce peri-operative blood loss. Femoral blocks and patient-controlled analgesia were used to facilitate early recovery. Aggressive physiotherapy was allowed. Patients were followed up at months 3, 6, and 12, and yearly thereafter. At the 2-year follow-up, the mean range of motion improved from 95º to 129º (p=0.032), the mean KSS from 120 to 158 (p<0.001), and the WOMAC from 51 to 88 (p=0.002). One patient developed patellar crepitus at week 6, which resolved with conservative treatment. Another patient developed infection in both knees at month 6. Despite salvage procedures, infection recurred after 3 months and the patient underwent bilateral arthrodesis. No patient developed deep vein thrombosis or pulmonary embolism, myocardial infarction, atrial fibrillation, or other cardiac event. Simultaneous bilateral TKR is safe for properly selected patients.