Kim Y-H, Choi Y-W, Kim J-S
The Joint Replacement Center of Korea, Ewha Womans University, School of Medicine, Seoul, Korea.
J Bone Joint Surg Br. 2009 Jan;91(1):64-8. doi: 10.1302/0301-620X.91B1.21320.
We wished to determine whether simultaneous bilateral sequential total knee replacement (TKR) carried increased rates of mortality and complications compared with unilateral TKR in low- and high-risk patients. Our study included 2385 patients who had undergone bilateral sequential TKR under one anaesthetic and 719 who had unilateral TKR. There were no significant pre-operative differences between the groups in terms of age, gender, height, weight, body mass index, diagnosis, comorbidity and duration of follow-up, which was a mean of 10.2 years (5 to 14) in the bilateral and 10.4 years (5 to 14) in the unilateral group. The peri-operative mortality rate (eight patients, 0.3%) of patients who had bilateral sequential TKR was similar to that (five patients, 0.7%) of those undergoing unilateral TKR. In bilateral cases the peri-operative mortality rate (three patients, 0.4%) of patients at high risk was similar to that (five patients, 0.3%) of patients at low risk as it was also in unilateral cases (two patients, 1.0% vs three patients, 0.6%). There was no significant difference (p = 0.735) in either the overall number of major complications between bilateral and unilateral cases or between low- (p = 0.57) and high-risk (p = 0.61) patients. Also, the overall number of minor complications was not significantly different between the bilateral and unilateral group (p = 0.143). Simultaneous bilateral sequential TKR can be offered to patients at low and high risk and has an expected rate of complications similar to that of unilateral TKR.
我们希望确定，与单侧全膝关节置换术（TKR）相比，在低风险和高风险患者中，同期双侧序贯全膝关节置换术是否会增加死亡率和并发症发生率。我们的研究纳入了2385例在一次麻醉下接受双侧序贯TKR的患者以及719例接受单侧TKR的患者。两组患者在年龄、性别、身高、体重、体重指数、诊断、合并症和随访时间方面术前均无显著差异，双侧组平均随访时间为10.2年（5至14年），单侧组为10.4年（5至14年）。接受双侧序贯TKR患者的围手术期死亡率（8例患者，0.3%）与接受单侧TKR患者的围手术期死亡率（5例患者，0.7%）相似。在双侧病例中，高风险患者的围手术期死亡率（3例患者，0.4%）与低风险患者的围手术期死亡率（5例患者，0.3%）相似，单侧病例中也是如此（2例患者，1.0%对3例患者，0.6%）。双侧和单侧病例之间或低风险（p = 0.57）和高风险（p = 0.61）患者之间的主要并发症总数均无显著差异（p = 0.735）。此外，双侧组和单侧组之间的次要并发症总数也无显著差异（p = 0.143）。同期双侧序贯TKR可提供给低风险和高风险患者，其并发症发生率与单侧TKR相似。
