Shah Kalpesh, Smith Julie, Jones Bryn, Hullin Michael
Southern General Hospital, Flat 1, 87 Cleveden Road, Glasgow, G12 0JN, UK.
Knee Surg Sports Traumatol Arthrosc. 2007 Mar;15(3):269-75. doi: 10.1007/s00167-006-0196-5. Epub 2006 Aug 26.
Bilateral knee replacement under single anaesthetic is not a common procedure. There is a general agreement that this is associated with greater morbidity and mortality. However, there is a suggestion in literature that using a cementless implant could reduce this risk. We wanted to make a prospective comparison of safety and clinical results, between unilateral and bilateral cementless knee replacements performed under a single anaesthetic. A prospective non-randomised matched cohort study on 87 consecutive patients who had bilateral simultaneous/sequential knee replacement and 174 consecutive patients who had unilateral knee replacement between the period of 1997 and 2002 were included in this study. All patients had a cementless mobile-bearing implant. All patients had an independent objective assessment at follow-up. There was no significant difference between the two groups in terms of age, sex, primary diagnosis (osteoarthritis or rheumatoid arthritis), co-morbidity, ASA grade, average range of motion and average American knee society score and post-operative surgical complications. There was one early death in the bilateral group, and three in the unilateral group. The clinical results of bilateral group were as good as the unilateral group. Our study showed that in terms of postoperative medical and surgical complications, bilateral simultaneous/sequential knee replacement using a cementless mobile-bearing implant is as safe as a unilateral knee replacement. With careful patient selection, bilateral knee replacement under a single anaesthetic would be a suitable option for patients who present with bilateral symptomatic arthritis of the knee.
在单次麻醉下进行双侧膝关节置换并非常见手术。人们普遍认为，这与更高的发病率和死亡率相关。然而，文献中有迹象表明，使用非骨水泥型植入物可能会降低这种风险。我们希望对在单次麻醉下进行的单侧和双侧非骨水泥型膝关节置换的安全性和临床结果进行前瞻性比较。本研究纳入了1997年至2002年期间连续87例接受双侧同期/序贯膝关节置换的患者和174例接受单侧膝关节置换的连续患者，进行前瞻性非随机配对队列研究。所有患者均使用非骨水泥型活动轴承植入物。所有患者在随访时均接受独立的客观评估。两组在年龄、性别、原发性诊断（骨关节炎或类风湿关节炎）、合并症、美国麻醉医师协会（ASA）分级、平均活动范围、平均美国膝关节协会评分及术后手术并发症方面无显著差异。双侧组有1例早期死亡，单侧组有3例。双侧组的临床结果与单侧组一样好。我们的研究表明，就术后医疗和手术并发症而言，使用非骨水泥型活动轴承植入物进行双侧同期/序贯膝关节置换与单侧膝关节置换一样安全。经过仔细的患者选择，对于双侧膝关节有症状性关节炎的患者，在单次麻醉下进行双侧膝关节置换将是一个合适的选择。
