Sheridan Gerard A, Moshkovitz Rotem, Masri Bassam A
Division of Lower Limb Reconstruction and Oncology, The University of British Columbia, Vancouver, Canada.
Bone Jt Open. 2022 Jan;3(1):29-34. doi: 10.1302/2633-1462.31.BJO-2021-0186.R1.
Simultaneous bilateral total knee arthroplasty (TKA) has been used due to its financial advantages, overall resource usage, and convenience for the patient. The training model where a trainee performs the first TKA, followed by the trainer surgeon performing the second TKA, is a unique model to our institution. This study aims to analyze the functional and clinical outcomes of bilateral simultaneous TKA when performed by a trainee or a supervising surgeon, and also to assess these outcomes based on which side was done by the trainee or by the surgeon.
This was a retrospective cohort study of all simultaneous bilateral TKAs performed by a single surgeon in an academic institution between May 2003 and November 2017. Exclusion criteria were the use of partial knee arthroplasty procedures, staged bilateral procedures, and procedures not performed by the senior author on one side and the trainee on another. Primary clinical outcomes of interest included revision and re-revision. Primary functional outcomes included the Oxford Knee Score (OKS) and patient satisfaction scores.
In total, 315 patients (630 knees) were included for analysis. Of these, functional scores were available for 189 patients (378 knees). There was a 1.9% (n = 12) all-cause revision rate for all knees. Overall, 12 knees in ten patients were revised, and both right and left knees were revised in two patients. The OKS and patient satisfaction scores were comparable for trainees and supervising surgeons. A majority of patients (88%, n = 166) were either highly likely (67%, n = 127) or likely (21%, n = 39) to recommend bilateral TKAs to a friend.
Simultaneous bilateral TKA can be used as an effective teaching model for trainees without any significant impact on patient clinical or functional outcomes. Excellent functional and clinical outcomes in both knees, regardless of whether the performing surgeon is a trainee or supervising surgeon, can be achieved with simultaneous bilateral TKA. Cite this article: 2022;3(1):29-34.
同期双侧全膝关节置换术（TKA）因其经济优势、整体资源利用以及对患者的便利性而被采用。在我们机构，有一种独特的培训模式，即由实习医生先进行第一侧TKA，随后由带教医生进行另一侧TKA。本研究旨在分析由实习医生或带教医生进行同期双侧TKA的功能和临床结局，并根据实习医生或医生所操作的侧别评估这些结局。
这是一项回顾性队列研究，纳入了2003年5月至2017年11月间在一所学术机构由一位外科医生进行的所有同期双侧TKA病例。排除标准包括使用部分膝关节置换手术、分期双侧手术以及资深作者未在一侧而实习医生未在另一侧进行的手术。感兴趣的主要临床结局包括翻修和再次翻修。主要功能结局包括牛津膝关节评分（OKS）和患者满意度评分。
总共纳入315例患者（630膝）进行分析。其中，189例患者（378膝）有功能评分数据。所有膝关节的全因翻修率为1.9%（n = 12）。总体而言，10例患者的12膝进行了翻修，2例患者的左右膝均进行了翻修。实习医生和带教医生的OKS及患者满意度评分具有可比性。大多数患者（88%，n = 166）极有可能（67%，n = 127）或有可能（21%，n = 39）向朋友推荐双侧TKA。
同期双侧TKA可作为实习医生的有效教学模式，对患者的临床或功能结局无显著影响。同期双侧TKA无论手术医生是实习医生还是带教医生，均可在双膝取得优异的功能和临床结局。引用本文：2022;3(1):29 - 34。
