Abstract
A significant number of patients with degenerative arthritis of the knee require bilateral knee arthroplasty. Single-stage bilateral total knee arthroplasty (SBTKR) has been associated with increased patient morbidity and mortality. At our institution, the following steps have been taken to minimize the risks to patients undergoing this procedure: regional anesthesia and analgesia, invasive monitoring, postoperative observation in an intensive care unit setting, and aggressive management of hemodynamic aberrations. We reviewed the medical records of 462 sequential total knee arthroplasty patients, consisting of 169 SBTKR and 293 unilateral total knee arthroplasty (UTKR) cases. A total of 122 patients from each group were matched for age, weight, and a history of ischemic heart disease and hypertension. Patients for SBTKR exhibited a significantly higher incidence of fat embolism syndrome and cardiac arrhythmias than UTKR patients. There were no deaths in either group and the incidence of other serious postoperative complications was low and similar between the two groups. Elderly patients (∼75 years old) had more postoperative complications. With aggressive clinical management SBTKR can be safely performed in selected patients. Guidelines for the selection of these patients are presented.
Similar content being viewed by others
References
JD Reuben SJ Meyers DD Cox et al. (1998) ArticleTitleCost comparison between bilateral simultaneous, staged, and unilateral total joint arthroplasty J Arthroplast 13 172–179 Occurrence Handle10.1016/S0883-5403(98)90095-X Occurrence Handle1:STN:280:DyaK1c7os12mug%3D%3D
DA Oakes AD Hanssen (2004) ArticleTitleBilateral total knee replacement using the same anesthetic is not justified by assessment of the risks Clin Orthop Relat Res 428 87–91 Occurrence Handle15534525
DP Bullock SM Sporer TG Shirreffs SuffixJr (2003) ArticleTitleComparison of simultaneous bilateral with unilateral total knee arthroplasty in terms of perioperative complications J Bone Jt Surg 85A 1981–1986
M Ritter LA Mamlin CA Melfi (1997) ArticleTitleOutcome implications for the timing of bilateral total knee arthroplasties Clin Orthop Relat Res 345 99–105 Occurrence Handle9418626
NM Lynch RT Trousdale DM Ilstrup (1997) ArticleTitleComplications after concomitant bilateral total knee arthroplasty in elderly patients Mayo Clin Proc 72 799–805 Occurrence Handle1:STN:280:ByiH2c%2FitFM%3D Occurrence Handle9294525
M Bould BJC Freeman A Pullyblank (1998) ArticleTitleBlood loss in sequential bilateral total knee arthroplasty J Arthroplast 13 77–79 Occurrence Handle10.1016/S0883-5403(98)90078-X Occurrence Handle1:STN:280:DyaK1c7lt1Ggtw%3D%3D
LD Dorr P Udomkiat J Szenobradszky et al. (2002) ArticleTitleIntraoperative monitoring for safety of bilateral total knee replacement Clin Orthop 396 142–151 Occurrence Handle11859237
MA Ritter LD Harty (2004) ArticleTitleDebate: Simultaneous bilateral knee replacements Clin Orthop Relat Res 428 84–86 Occurrence Handle15534524
J Parizi TA Sullivan RT Trousdale et al. (2001) J Bone Jt Surg 83A 1157–1161
V Pavone T Johnson PS Saulog et al. (2004) ArticleTitlePerioperative morbidity in bilateral one-stage total knee replacements Clin Orthop Relat Res 421 155–161 Occurrence Handle15123941
GJ Lane WJ Hzack S Shah (1997) ArticleTitleSimultaneous bilateral versus unilateral total knee arthroplasty Clin Orthop Relat Res 345 106–112 Occurrence Handle9418627
PC Herbert G Wells MA Blajchman et al. (1999) ArticleTitleA multicenter, randomized, controlled clinical trial of transfusion requirements in critical care N Engl J Med 340 409–417
JL Parmet JC Horrow R Singer et al. (1994) ArticleTitleEchogenic emboli upon tourniquet release during total knee arthroplasty: pulmonary hemodynamic changes and embolic composition Anesth Analg 79 940–945 Occurrence Handle1:STN:280:ByqD28bgvFQ%3D Occurrence Handle7978413
SA Schonfeld Y Ploysongsang R Lasio ParticleDi et al. (1983) ArticleTitleFat embolism prophylaxis with corticosteroids: a prospective study in high risk patients Ann Intern Med 99 438–443 Occurrence Handle1:STN:280:BiuD383ht1I%3D Occurrence Handle6354030
LD Dorr C Merkel MF Mellman et al. (1989) ArticleTitleFat emboli in bilateral total knee arthroplasty: Predicting factors for neurologic manifestations Clin Orthop 248 112–118 Occurrence Handle2805467
MD Rites LA Rauscher S Hoskins et al. (1998) ArticleTitleIntramedulary pressure and pulmonary function during total knee arthroplasty Clin Orthop 356 154–160
A Rodgers N Walker S Schug et al. (2000) ArticleTitleReduction of postoperative mortality and morbidity with epidural or spinal anesthesia: Results from overview of randomized trials BMJ 321 1–12 Occurrence Handle10.1136/bmj.321.7275.1493
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Urban, M.K., Chisholm, M. & Wukovits, B. Are Postoperative Complications More Common with Single-Stage Bilateral (SBTKR) Than with Unilateral Knee Arthroplasty: Guidelines for Patients Scheduled for SBTKR. HSS Jrnl 2, 78–82 (2006). https://doi.org/10.1007/s11420-005-0125-z
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11420-005-0125-z