Unlike the NJR, no surgeon driven national database currently exists for ligament surgery in the UK and therefore information on outcome and adverse event is limited to case series. Prospectively collected Hospital episode statistics (HES) data for England was analysed so as to determine national rates of 90-day symptomatic deep venous thrombosis (DVT), pulmonary thromboembolism (PTE) rate, significant wound infection and 30-day readmission rates with cause following anterior cruciate ligament (ACL) reconstruction. This diagnostic and operative codes information is routinely collected on every patient admitted to hospital in England NHS.Introduction
Methods
Simultaneous bilateral Total Knee Arthroplasty (TKA) has been reported to bring greater patient satisfaction, reduce in-patient stay and recovery, with similar outcomes to single sided or staged TKA, but higher complication rates. No validated selection criteria exist. We report the results of a single surgeon's experience of simultaneous bilateral TKA, using set guidelines for patient selection. A prospectively maintained database of all simultaneous bilateral TKA performed between 2002 and 2008 was retrospectively analysed, supplemented by case-note review. Outcome measures included length of stay, blood loss and transfusion rates, complications and functionality and validated outcome scores. 40 patients were included, 23 male and 17 female, all with osteoarthritis. Mean age was male 64.9 and female 61.3 years. Mean ASA grade was 1.8. All fitted selection criteria. Mean tourniquet time was right 79.1 minutes and left 83.6 minutes. Preoperative mean haemoglobin level was 141.8 g/dl and mean post operative level of 87.3 g/dl. 13 patients received purely autologous blood transfusion, 16 patients purely allogenic and 6 patients received both. There was 1 intraoperative complication (Medial collateral injury), 3 minor post operative complications which recovered prior to discharge. There were no thromboembolic events or deaths. Mean follow-up was 32.7 months (range 3-79 months). Mean in-patient stay was 7.5 days. Mean range of movement at most recent follow up was right 1.0 to 119.1 degrees flexion and left 1.0 to 120.8 degrees flexion. Mean Knee Society Scores pre- versus post-operatively were: 67 knee/62 function versus 90 knee/82 function. Oxford Knee Scores, Pre- versus post-operatively were: 43 versus 35 (Scoring 0-60, lowest best outcome). We demonstrate that with appropriate selection criteria, simultaneous bilateral TKA is safe and successful, giving excellent functional outcomes.
