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Bilateral Total Knee Replacement
(Both Knee Joints-Total Knee Replacement) |
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One or both knees may be affected by arthritis.
If both knee joints show changes on X-rays and only
one knee joint is painful, stiff, and disturbs daily
activities of life, then only the painful knee joint
should be operated on. If both knees are equally
painful, then both should be operated on.
The surgery that replaces both damaged knee joints
is called bilateral
total knee replacements.
Bilateral knee surgery is done routinely and it
presents one of the most spectacular successes of
the total knee replacement surgery.
This is so because two impaired knee joints cause
much more symptoms and severe disability. In people
with both knee joints affected, they have no healthy
leg to rely on during the post operative rehabilitation!
Staged
Total Knee Replacement
The surgeon replaces the arthritic knee joint one
at a time, at two separate operations, often several
days to several months apart. The patient will need
two hospital stays, two anesthesia and two rehabilitation
periods. This is called Staged
Total Knee Replacement.
Simultaneous Bilateral Total Knee Replacement
If both knees are equally painful and stiff, it
is possible to have both knees replaced during one
operation under one anesthesia. The operations are
followed by a single rehabilitation period within
one hospital stay. Such two simultaneous surgeries
are called Simultaneous Bilateral Total
Knee Replacement or single sitting bilateral total
knee replacement. |
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Are the results
of Simultaneous Total knee replacement equally good
as the results of Staged Total knee replacement? |
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Both procedures produce equally good relief of
pain and equally good return of function in the
operated knees. The decision is based on the health
status of the patient and is made in collaboration
with the anesthetist.
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What are
the advantages of a Simultaneous Total knee replacement? |
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The patient will have only one surgical "event",
single anesthesia, and a shorter hospital stay.
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What are
the risks of a Simultaneous Total Knee replacement? |
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In comparison with staged procedure the risks
with Simultaneous TKR are:
Three times increased risk of death during the
30 days period for people > 70 years (Parvizi,
2001)
Twice increased risk of complications, especially
vascular complications such as deep vein thrombosis
(Ritter 1997)
Much higher need (17 times) for banked blood
with all possible complications (Lane 1997)
Three times increased
risk of cardiopulmonary complications
Twice increased length
of the stay at the intensive unit department
Twice increased need
for prolonged rehabilitation
Higher rate of bone
marrow emboli into the brain (Sulek 1999)
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What are
the advantages of a Staged Total knee replacement
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Lower stress on cardiovascular system, less complications,
less risk for requiring allogenic (banked) blood.
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Who should have a Simultaneous Bilateral Total Knee replacement? |
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The ideal candidate is a patient under 70 years
of age (some surgeons accept even older patients,
up to 80 years), in good physical condition, without
cardiac, pulmonary or vascular diseases. Such
patients should also have severe pain in both
knees that interferes with the activities of daily
living. There should be signs of knee joint damage
on X-ray pictures of both knees.
Because there are significant risks associated
with Simultaneous Total knee replacement, a very
careful evaluation of candidates is necessary.
The patients should also be informed about the
risks associated with this procedure.
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Should the X-ray changes of the other knee alone decide the bilateral operation? |
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If the patient has one bad knee and one good knee
BUT both knees show X-ray signs of osteoarthritis,
then should the patient have both knees replaced
at once?
• The answer is No. Total knee replacement only
of that knee joint which gives pain and
stiffness
is advisable.
• X ray findings should not dictate surgical decisions!
It is important to discuss with the
patient the
pros and cons and thoroughly examine clinically
before arriving at a decision.
• There is, however, a 75 % chance that the second
symptomless knee (with apparent X-ray
changes)
will become painful during the next five years.
However if that happens then a
total knee replacement
can always be done at that stage.
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Will the impairment of the other knee recede after operation on one side? |
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• If both knee joints have severe flexion deformity
(knees that are stiff in bent position)
• In aged patients. In these patients a medical
complication may develop and prevent the
operation
of the other knee. An elderly patient, who was
suffering misery from bilateral
knee impairment
is able to function "normally" in 2 to 3 weeks
after bilateral replacement.
The state of depression
of these patients often improves after their source
of pain has
been removed.
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Patients not suitable for TOTAL KNEE SURGERY |
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(of one or both knees)
• Patients with recent heart infarct and stroke
• Patients with uncontrolled diabetes, lung, kidney,
or other systemic disease
• Patients with ongoing or recent infection in
the knee joint area
• Patients with severe paralysis of muscles around
the knee
• Patients with severe circulation problems (painful
claudication) in the extremity.
• Patients with severe skin damage in the front
of the knee joint
• Patients with open wounds in the lower leg.
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Other reasons why surgeons may advice against operation |
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Many surgeons will hesitate to carry out total
knee replacement in
• badly motivated patients
• patients seeking financial or other gain from
total knee surgery
• persons with alcohol abuse
• people with dementia (Mancuso 1996)
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