By Nilesh Patil, MS(Orth); Hemant Wakankar, MS, FRCS, Mch(Orth), FRCS(Orth)
ORTHOPEDICS 2008; 31:780
Total knee arthroplasty (TKA) is an effective treatment for end-stage arthritis of the knee. Published studies in the literature have consistently reported TKA as an efficacious and cost-effective means of alleviating pain and restoring function.1,2 A significant number of patients with severe end-stage degenerative joint disease have symptomatic bilateral knee joint affliction, necessitating joint replacement in both knees.3-5 The surgical options available for these patients include a staged procedure with a certain time interval between 2 procedures, simultaneous arthroplasty of both knees using 2 surgical teams, or bilateral arthroplasty using 1 team with the patient under 1 anesthetic. However, the decision to perform bilateral knee arthroplasty staged or simultaneous is debated.
Advantages of bilateral TKA performed under 1 anesthetic compared with bilateral arthroplasty conducted as a 2-staged procedure are well known and include limiting an invasive surgical procedure and anesthesia to a single event and promoting symmetrical rehabilitation of both knees, potentially reducing the length of the hospital stay and thereby the hospital costs associated with TKA.3,5-8
The authors in support of simultaneous bilateral TKA are of the opinion that with appropriate patient selection, the potential benefits of conducting this procedure in a simultaneous fashion outweigh the possible risks of the procedure. In a study evaluating the safety of simultaneous bilateral TKA, Lombardi et al9 reported that performing bilateral TKA in a simultaneous manner is advantageous, and 95% of patients would prefer to undergo the procedure in a similar manner if presented with the same opportunity again.