BILATERAL SIMULTANEOUS TWO SURGEON KNEE REPLACEMENT – EFFICIENT, SAFE AND EDUCATIONAL

Abstract

Aim: To assess the safety and efficiency of bilateral simultaneous total knee replacement surgery using a retrospective notes based review.

Methods: We performed a retrospective case note review of a series of 112 bilateral simultaneous knee replacements performed over a five year period in a district general hospital. (224 joints – 142 total joints, 82 unicompartmental). The procedures were all performed by a consultant knee surgeon operating alongside a knee fellow. Patients were only offered bilateral procedures if in ASA class I/II. (any borderline candidates were referred for anaesthetic assessment). Results were obtained for a number of parameters to assess the safety of this technique by measuring rates of both minor and major complications. Data was also gathered to assess the efficiency of the technique – measuring both tourniquet times and length of stay.

Results: Over the period of five years there were no deaths or major complications reported. There were three cases of DVT (2.6%) and one case of PE (0.9%). There were three cases of superficial wound infection (2.6%), one of joint infection (0.9%) and one of aseptic loosening (0.9%). Average tourniquet time was 76 minutes with an average length of stay of 8.6 nights.

Conclusion: Bilateral simultaneous knee replacement is a valuable technique which offers the patient a single operation and recovery period, and return to normal life. In addition, the complication rates are acceptable, unlike several studies looking at bilateral procedures performed back to back. It also offers an excellent training opportunity for the 2^nd surgeon to operate under close supervision. In an increasingly time pressured health service we believe this procedure is an efficient and safe technique when used in suitable patients.