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The necessity for simultaneous bilateral total knee arthroplasty: a neglected point in patients with severe deformity
ESSKA Academy. Ganji R. Nov 8, 2019; 284379; epEKA-42 Topic: Joint Replacement
Dr. Rashid Ganji
Dr. Rashid Ganji
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The necessity for simultaneous bilateral total knee arthroplasty: a neglected point in patients with severe deformity

ePoster - epEKA-42

Topic: TKA

Ganji R.1, Zarifian A.2, Ganji S.1, Ghaboulian N.1
1Sina Hospital, Department of Orthopedics, Mashhad, Iran, Islamic Republic of, 2Mashhad University of Medical Sciences, Orthopedic Research Center, Mashhad, Iran, Islamic Republic of

Introduction: There is controversy regarding whether it is more advantageous to perform simultaneous bilateral total knee arthroplasty (SBTKA) or staged TKA. On the one hand, SBTKA leads to better recovery, shorter hospital stay, less costs, and requiring anesthesia once. On the other hand, some surgeons believe that SBTKA has a higher chance of complications and mandates careful patient selection.
Objectives: An important yet neglected point in this regard is that patients with severe bilateral deformity who have balanced gait should be exclusively treated with SBTKA. Staged TKA approach in such patients might result in an imbalanced gait and more difficulty walking, which in turn leads to further complications, i.e. falling, hip fractures, and peri-prosthetic fractures. Moreover, patients put more pressure and weight on the operated knee, which reduces the longevity of prosthesis. This problem is more critical in developing countries, where TKA is not well received by patients. Therefore, performing unilateral TKA and postponing the other side for later stages would reduce the patient satisfaction and might end in forgoing the second TKA. This often results in aggravated arthritis in the non-operated knee and complications in the prosthesis.
Aims: We intend to assess the necessity of SBTKA in patients with severe deformity who referred to our clinic for TKA.
Methods: In this ethically approved cross-sectional prospective study, we included all knees operated in our center during Mach 2016-April 2017. All TKAs performed by one single surgeon were extracted from a single-center database comprising over 5000 TKA operations. Outcome was measured by severity of deformity, need for SBTKA (bilateral deformity), and referring of patients for second TKA during a 2-year follow-up.
Results: Overall, 672 patients were operated, of whom 86.7% were female. The mean age was 66.78±7.21 years. Of 672 patients, 63 (36.62%) had bilateral severe (>15 deg) deformity and were operated bilaterally. Unilateral TKA was done in 156 (25.63%) patients, among whom 54 (34.6%) needed TKA for both sides according to physical exam and imaging. However, only 15 (27.7%) referred for the second TKA.
Conclusion: It seems necessary to perform SBTKA in patients with severe deformities, even if the patients are high-risk. It might be better to reconsider performing TKA than to perform staged unilateral TKA in patients suffering from such deformities.
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