Ayekoloye C, Balogun M, Oyewole G, Ogunlade S, Alonge T, Adeoye Sunday
Department of Orthopaedics and Trauma, University College Hospital, Ibadan.
Ann Ib Postgrad Med. 2023 Jun;21(1):17-21.
Bilateral end-stage knee osteoarthritis is a common presentation. The decision facing both patient and surgeon is whether to undertake the replacement of both knees in one sitting i.e. simultaneous bilateral total knee replacement (SMTKR) or to undertake this as a staged bilateral total knee replacement (STTKR). The decision is made harder by the presence of severe coronal and sagittal plane deformities and associated bone loss. We present our results of treating such patients with a focus on a trilogy of cost, complication and functional outcome following SMTKR.
A retrospective review of 31 patients who presented with bilateral knee arthritis. 19 underwent SMTKR and 12 underwent STTKR. Data on the trilogy of complication, cost and functional outcome were collected and analysed.
Our cohort of patients was overwhelmingly female in both groups at overall F/M = 30/1. Patients in the SMTKR group were slightly younger at a mean of 65 years compared to 69 years in the STTKR group. Mean Oxford Knee Score (OKS) improved significantly in all groups, mean of 54 in SMTKR and 56 in the STTKR groups. There was one fatality in the STTKR from upper GI bleeding and 1 revision for bone graft failure. The overall cost is less with SMTKR.
SMTKR is a safe and effective undertaking in properly selected patients with bilateral end-stage knee arthritis with severe deformities. Significant experience is however needed to successfully tackle complex deformities and such procedures should be undertaken by experienced arthroplasty surgeons.
双侧终末期膝骨关节炎是一种常见病症。患者和外科医生面临的决策是，是否一次性进行双膝置换，即同时双侧全膝关节置换术（SMTKR），还是分阶段进行双侧全膝关节置换术（STTKR）。严重的冠状面和矢状面畸形以及相关的骨质流失使这一决策更加困难。我们展示了治疗此类患者的结果，重点关注SMTKR后的成本、并发症和功能结果这三个方面。
对31例双侧膝关节炎患者进行回顾性研究。19例接受了SMTKR，12例接受了STTKR。收集并分析了关于并发症、成本和功能结果这三个方面的数据。
两组患者中女性占绝大多数，总体男女比例为30/1。SMTKR组患者稍年轻，平均年龄为65岁，而STTKR组为69岁。所有组的平均牛津膝关节评分（OKS）均显著改善，SMTKR组平均为54分，STTKR组平均为56分。STTKR组有1例因上消化道出血死亡，1例因骨移植失败进行翻修。SMTKR的总体成本更低。
对于双侧终末期膝关节炎伴严重畸形的合适患者，SMTKR是一项安全有效的手术。然而，成功处理复杂畸形需要丰富的经验，此类手术应由经验丰富的关节置换外科医生进行。
