C. Ayekoloye, M. Balogun, G. OyewC. Ayekoloye, M. Balogun, G. Oyewole, S. Ogunlade, T. Alonge, Adeoye-Sunday
- Department of Orthopaedics and Trauma, University College Hospital, Ibadan.
Abstract
Background: Bilateral end-stage knee osteoarthritis is a common presentation. The decision facing both patient and surgeon is whether to 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.
Methodology: 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
Result: 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.
Summary: 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.
Keywords: Osteoarthritis, Simultaneous, Staged, Arthroplasty, Complex deformities
Correspondence:
Dr. M. Balogun
Dept. of Orthopaedics and Trauma,
University College Hospital,
Ibadan
Email: mosibalogun@gmail.com
Date of Acceptance: 30th March, 2023
Publication Date: June 2023
Introduction
Total knee replacement results in excellent relief of pain, restoration of function and significant improvement in the quality of life of those with endstage knee arthritis.1 Because total knee arthroplasty has only recently become more widely available in Nigeria, many of our patients have had no option but to put up with the disability of end-stage knee arthritis. Patients are now coming forward for total knee replacement, many of who present with bilateral often severe longstanding knee osteoarthritis. The decision facing both patient and surgeon then is either to replace both knees in one sitting under the same anaesthetic (simultaneous bilateral total knee replacement, SMTKR) or replace one knee first followed by replacement of the other knee after an interval of time (staged bilateral total knee replacement, STTKR). Compounding this decision is the additional need to undertake the complex reconstruction of one or both knees for severe coronal plane deformities often with significant bone loss and flexion contractures.
Recent discussions about total knee replacements had focused on the trilogy of cost, complications, and outcome2 with continuing debate regarding the safety of SMTKR.3,4,5
complication with SMTKR, is this approach justified in patients who in addition require complex reconstruction of one or both knees for severe deformity?
The aim is to present our experience with bilateral total knee replacements for complex bilateral knee osteoarthritis, focusing on functional outcome, cost and complication with both SMTKR and STTKR.