Křivánek S, Hrubina M, Chmúrny M, Rovňák M, Melišík M, Nečas L
Acta Chir Orthop Traumatol Cech. 2016;83(6):405-410.
PURPOSE OF THE STUDY Evaluation of short-term functional results in patients undergoing one-stage surgery involving sequential bilateral total knee arthroplasty (TKA) and comparison with the results of patients after unilateral TKA. MATERIAL AND METHODS The group with bilateral TKA consisted of 171 patients with 342 total knee replacements treated between 2009 and 2013. The control group included 50 patients with 50 TKAs operated on in the years 2010 to 2012. The indications to bilateral knee replacement included bilateral gonarthrosis, grade III or more in patients who were in good health and had a stable knee joint with axis deviation up to 20 degrees. A cemented TKA was used and the posterior cruciate ligament was preserved. Assessment of functional results was based on the Womac score, Knee Society Score (KSS 1, 2) range of motion and presence of specific complications in both groups. The follow-up lasted three years. RESULTS The average results in the bilateral vs the control group were as follows: the Womac score, 39.4/42.2 pre-operatively, 87.2/71.0 at 3 years; KSS 1, 48.5 / 44.8 pre-operatively, 87.4 / 79.9 at 3 years; KSS 2, 44.1 / 50.6 pre-operatively, 86.1 / 72.8 at 3 years; motion-flexion, 105.2° / 105.7° preoperatively, 114.0° / 100.2° at 3 years. In the bilateral group, infection was recorded in one patient. DISCUSSION Bilateral total knee replacement is a controversial issue. A higher risk of non-specific complications has been reported. Functional outcomes are good. The key problem is to set the correct indication to this procedure after an individual assessment of the patient's general health condition and the state of his/her knee joints. CONCLUSIONS The patients undergoing bilateral TKA at one-stage surgery showed functional results comparable (range of motion was even better) with the results of the unilateral TKA group. The number of specific complications was low. Every patient should be carefully assessed. Key words: total knee arthroplasty, bilateral implantation, functional results.
评估一期序贯双侧全膝关节置换术（TKA）患者的短期功能结果，并与单侧TKA患者的结果进行比较。材料与方法：双侧TKA组由2009年至2013年间接受治疗的171例患者共342次全膝关节置换组成。对照组包括2010年至2012年间接受手术的50例患者共50次TKA。双侧膝关节置换的指征包括双侧膝关节病，健康状况良好、膝关节稳定且轴线偏差不超过20度的III级或更高级别患者。采用骨水泥型TKA，保留后交叉韧带。基于Womac评分、膝关节协会评分（KSS 1、2）、活动范围以及两组中特定并发症的存在情况对功能结果进行评估。随访持续三年。结果：双侧组与对照组的平均结果如下：Womac评分，术前39.4/42.2，3年后87.2/71.0；KSS 1，术前48.5 / 44.8，3年后87.4 / 79.9；KSS 2，术前44.1 / 50.6，3年后86.1 / 72.8；活动度 - 屈曲，术前105.2° / 105.7°，3年后114.0° / 100.2°。在双侧组中，有1例患者出现感染。讨论：双侧全膝关节置换是一个有争议的问题。已报道非特异性并发症风险较高。功能结果良好。关键问题是在对患者的总体健康状况和膝关节状态进行个体评估后，为该手术设定正确的指征。结论：一期接受双侧TKA的患者显示出与单侧TKA组相当的功能结果（活动范围甚至更好）。特定并发症数量较少。每位患者都应进行仔细评估。关键词：全膝关节置换术，双侧植入，功能结果
