Complication rate and patient satisfaction following simultaneous bilateral total knee replacement

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Abstract

BACKGROUND: Advanced knee osteoarthritis (OA) is a common clinical problem requiring knee arthroplasty. X-ray can be used to diagnose knee osteoarthritis. Total knee arthroplasty of the two knees can be done simultaneously or staged in two different sessions.

AIM: To assess simultaneous bilateral total knee arthroplasty based on complications and patient satisfaction and compare the results to those in the literature to provide a clear guideline for appropriate choice for patients.

MATERIALS AND METHODS: A prospective cohort study was conducted in Ain Shams University Hospital in Cairo and Taiba Hospital in Kuwait on 45 cases who suffered from advanced bilateral knee osteoarthritis and underwent simultaneous bilateral total knee arthroplasty between August 2018 and October 2020.

RESULTS: The study was conducted on 45 patients aged 47–75 years (mean age: 64.29±6.23 years). There were 41 females (91.1%) and 4 males (8.9%). Pre- and postoperative patient satisfaction was 15.24±2.45 and 32.18±4.08, respectively, with a mean difference of 16.93. Moreover, the pre- and postoperative objective knee score and Knee Society Scoring System, were 58.90±6.28 and 82.62±5.70, respectively. Additionally, the pre- and postoperative functional knee score were 51.39±8.67 and 73.80±7.75, respectively. Four patients (8.9%) had complications: 3 (6.7%) had superficial infection and 1 (2.2%) had acute coronary syndrome.

CONCLUSION: Simultaneous bilateral total knee arthroplasty can be safe and have low mortality and complication rates with careful preoperative patient selection.

About the authors

Amr A. Hammad

Ain Shams University

Author for correspondence.
Email: amrkader67@yahoo.com

MD

Egypt, Cairo

Radwan G. Abd El Hamid

Ain Shams University

Email: radwanmetwaly@med.asu.edu.eg

MD

Egypt, Cairo

Mohamed E. Awad

Ain Shams University

Email: Mohamed_awad2007@hotmail.com

MD

Egypt, Cairo

Mohab E. Elkilany

Ain Shams University

Email: Mohabelkilany@gmail.com

MSc

Egypt, Cairo

References

  1. Altman RD, Gold GE. Atlas of individual radiographic features in osteoarthritis, revised. Osteoarthritis Cartilage. 2007;15 Suppl A:A1–56. doi: 10.1016/j.joca.2006.11.009
  2. Scott CEH, Howie CR, MacDonald D. Predicting dissatisfaction following total knee replacement: a prospective study of 1217 patients. J Bone Joint Surg Br. 2010;92(9):1253–8. doi: 10.1302/0301-620X.92B9.24394
  3. Mündermann A, Dyrby CO, Andriacchi TP. Secondary gait changes in patients with medial compartment knee osteoarthritis: increased load at the ankle, knee, and hip during walking. Arthritis Rheum. 2005;52(9):2835–44. doi: 10.1002/art.21262
  4. Odum SM, Troyer JL, Kelly MP, Dedini RD, Bozic KJ. A cost-utility Analysis comparing the cost-effectiveness of simultaneous and staged bilateral total knee arthroplasty. J Bone Joint Surg Am. 2013;95(16):1441–9. doi: 10.2106/JBJS.L.00373
  5. Hooper GJ, Hooper NM, Rothwell AG, Hobbs T. Bilateral total joint arthroplasty: the early results from the New Zealand National Joint Registry. J Arthroplasty. 2009;24(8):1174–7. doi: 10.1016/j.arth.2008.09.022
  6. Hussain N, Chien T, Hussain F, et al. Simultaneous versus staged bilateral total knee arthroplasty a meta-analysis evaluating mortality, peri-operative complications and infection rates. HSS J. 2013;9(1):50–9. doi: 10.1007/s11420-012-9315-7
  7. Husted H, Troelsen A, Otte KS, et al. Fast-track surgery for bilateral total knee replacement. J Bone Joint Surg Br. 2011;93(3):351–6. doi: 10.1302/0301-620X.93B3.25296
  8. Hu J, Liu Y, Lv Z, Li X, Qin X, Fan W. Mortality and morbidity associated with simultaneous bilateral or staged bilateral total knee arthroplasty: a meta-analysis. Arch Orthop Trauma Surg. 2011;131(9):1291–8. doi: 10.1007/s00402-011-1287-4
  9. Noble J, Goodall JR, Noble DJ. Simultaneous Bilateral Total Knee Replacement: A persistent controversy. The Knee. 2009;16(6):420–6. doi: 10.1016/j.knee.2009.04.009
  10. Alghadir AH, Iqbal ZA, Anwer S, et al. Comparison of simultaneous bilateral versus unilateral total knee replacement on pain levels and functional recovery. BMC Musculoskelet Disord. 2020;21(1):246. doi: 10.1186/s12891-020-03269-3
  11. Levy Y, Azar M, Raffaelli A, Tran L, Carles M, et al. One-Session Bilateral Total Knee Replacement: Late Complications and Survivorship. Orthopaedics & Traumatology: Surgery & Research. 2020;106(5):903–906. doi: 10.1016/j.otsr.2020.02.017
  12. Wan RC, Fan JC, Hung YW, Kwok KB, et al. Cost, Safety, and Rehabilitation of Same-Stage, Bilateral Total Knee Replacements Compared to Two-Stage Total Knee Replacements. Knee Surgery & Related Research. 2021;33(1):17. doi: 10.1186/s43019-021-00098-z
  13. Gromov K, Troelsen A, Stahl Otte K, et al. Morbidity and Mortality after Bilateral Simultaneous Total Knee Arthroplasty in a Fast-Track Setting. Acta Orthopaedica. 2016;87(3):286–90. doi: 10.3109/17453674.2016.114163
  14. Sarzaeem MM, Omrani FA, Abousaidi SR, et al. Comparison of Staged Bilateral and Simultaneous Bilateral Total Knee Arthroplasty in Deep Vein Thrombosis Occurrence. Trauma Monthly, In Press. 2017.
  15. Wong E, Nguyen CL, Park S, et al. Simultaneous, Same-Anaesthetic Bilateral Total Knee Arthroplasty Has Low Mortality and Complication Rates. Knee Surgery, Sports Traumatology, Arthroscopy. 2018;26(11):3395–3402. doi: 10.1007/s00167-018-4908-4
  16. Liu L, Liu H, Zhang H, Song J, et al. Bilateral Total Knee Arthroplasty. Simultaneous or staged? A systematic review and meta-analysis. Medicine (Baltimore). 2019;98(22):e15931. doi: 10.1097/MD.0000000000015931
  17. Mardani-Kivi M, Leili EK, Azari Z, et al. Bilateral Total Knee Arthroplasty: Simultaneous versus Staging in the Same or in Twice Hospitalization. Journal of Clinical Orthopaedics and Trauma. 2020;14:59–64. doi: 10.1016/j.jcot.2020.09.023
  18. Najfeld M, Kalteis T, Spiegler C, Ley C, et al. The Safety of Bilateral Simultaneous Hip and Knee Arthroplasty versus Staged Arthroplasty in a High-Volume Center Comparing Blood Loss, Peri- and Postoperative Complications, and Early Functional Outcome. Journal of Clinical Medicine. 2021;10(19):4507. doi: 10.3390/jcm10194507

Supplementary files

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2. Fig. 1. Medial parapatellar approach: skin incision (a) and deep dissection (b).

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3. Fig. 2. Marking the transepicondylar axis and whiteside line.

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4. Fig. 3. a — placing distal femoral jig, b — making distal femoral cut.

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5. Fig. 4. a — measuring jig for femoral cut, b — the 4-in-1 cutting jig applied to the femur.

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6. Fig. 5. a — measuring the proximal tibial cut, b — making a tibial cut.

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7. Fig. 6. Tibial sizing and preparation.

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8. Fig. 7. Checking the whole alignment of the limb after full trial insertion.

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9. Fig. 8. Washing and suctioning prior to final implant insertion.

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10. Fig. 9. Placing the final tibial implant (a), final femoral implant (b), and polyethylene liner (c).

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11. Fig. 10. Drain insertion and wound closure.

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12. Fig. 11. Ap preoperative x-ray showing bilateral knee osteoarthritis.

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13. Fig. 12. Lateral preoperative x-ray right and left knees showing osteoarthritis.

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14. Fig. 13. Ap postoperative x-ray showing bilateral total knee arthroplasty.

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15. Fig. 14. Lateral postoperative x-ray right and left knees showing bilateral total knee arthroplasty.

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16. Fig. 15. Ap preoperative x-ray showing bilateral knee osteoarthritis.

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17. Fig. 16. Lateral preoperative x-ray right and left knees showing osteoarthritis.

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18. Fig. 17. Ap postoperative x-ray showing bilateral total knee arthroplasty.

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19. Fig. 18. Lateral postoperative x-ray right and left knees showing bilateral total knee arthroplasty.

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20. Fig. 19. Ap preoperative x-ray showing bilateral knee osteoarthritis.

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21. Fig. 20. Lateral preoperative x-ray right and left knees showing osteoarthritis.

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22. Fig. 21. Ap postoperative x-ray showing bilateral total knee arthroplasty.

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23. Fig. 22. Lateral postoperative x-ray right and left knees showing bilateral total knee arthroplasty.

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24. Fig. 23. Ap preoperative x-ray showing bilateral knee osteoarthritis.

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25. Fig. 24. Lateral preoperative x-ray right and left knees showing osteoarthritis.

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26. Fig. 25. Ap postoperative x-ray showing bilateral total knee arthroplasty.

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27. Fig. 26. Lateral postoperative x-ray right and left knees showing bilateral total knee arthroplasty.

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