Mutsuzaki Hirotaka, Watanabe Arata, Komatsuzaki Tetsuya, Kinugasa Tomonori, Ikeda Kotaro
Department of Orthopaedic Surgery, Ibaraki Prefectural University of Health Sciences, 4669-2 Ami, Ami-machi, Inashiki-gun, Ibaraki, 300-0394, Japan.
Department of Orthopaedic Surgery, Ichihara Hospital, 3681 Ozone, Tsukuba, Ibaraki, 300-3295, Japan.
J Orthop Surg Res. 2018 Jan 17;13(1):14. doi: 10.1186/s13018-018-0720-6.
An increased perioperative complication rate has been a concern with one-stage bilateral total knee arthroplasty (TKA). The purpose of this study was to retrospectively investigate the perioperative safety and clinical results of one-stage bilateral TKA in selected low-risk patients.
Sixty-seven patients who received one-stage bilateral TKAs for osteoarthritis who were American Society of Anesthesiology (ASA) class 1 or 2 were included in this study. Perioperative complications, blood loss, transfusion rate, blood laboratory results, and clinical results were evaluated up to 1 year after surgery.
No major complications (deep infection, pulmonary embolism, cerebrovascular accident, myocardial infarction, death, or removal or revision of the implants) were observed. The average total blood loss was 1139.5 ml. The transfusion rate was 95.5%. Postoperative hemoglobin level and C-reactive protein level gradually improved up to postoperative day 21 (P < 0.01). Bilateral knee extension knee angles and clinical scores improved postoperatively as compared with preoperative values (P < 0.01).
Although total blood loss and transfusion rate can be high, this preliminary case series suggested that the one-stage bilateral TKA in ASA class 1 or 2 patients can have high perioperative safety levels, and good clinical results can be obtained up to 1 year after surgery. If low-risk patients are selected for bilateral TKA, a one-stage procedure can be beneficial for patients, with a minimal increase in the risk of complications.
一期双侧全膝关节置换术（TKA）的围手术期并发症发生率增加一直是人们关注的问题。本研究的目的是回顾性调查在选定的低风险患者中一期双侧TKA的围手术期安全性和临床结果。
本研究纳入了67例因骨关节炎接受一期双侧TKA且美国麻醉医师协会（ASA）分级为1或2级的患者。对围手术期并发症、失血量、输血率、血液实验室检查结果和临床结果进行术后1年的评估。
未观察到重大并发症（深部感染、肺栓塞、脑血管意外、心肌梗死、死亡或植入物取出或翻修）。平均总失血量为1139.5毫升。输血率为95.5%。术后血红蛋白水平和C反应蛋白水平在术后第21天前逐渐改善（P<0.01）。与术前值相比，双侧膝关节伸直角度和临床评分术后有所改善（P<0.01）。
尽管总失血量和输血率可能较高，但这个初步病例系列表明，ASA分级为1或2级患者的一期双侧TKA围手术期安全性较高，术后1年内可获得良好的临床结果。如果选择低风险患者进行双侧TKA，一期手术对患者可能有益，并发症风险增加最小。
