Aims. 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. Methods. 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. Results. 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. Conclusion. 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: Bone Jt Open 2022;3(1):29–34

Aims. Many patients undergoing total knee arthroplasty (TKA) have severe osteoarthritis (OA) in both knees and may consider either simultaneous or staged bilateral TKA. The implications of simultaneous versus staged bilateral TKA for return to work are not well understood. We hypothesized that employed patients who underwent simultaneous bilateral TKA would have significantly fewer days missed from work compared with the sum of days missed from each operation for patients who underwent staged bilateral TKA. Methods. The prospective arthroplasty registry at the Hospital for Special Surgery was used. Baseline characteristics and patient-reported outcome scores were evaluated. We used a linear regression model, adjusting for potential confounding variables including age, sex, preoperative BMI, and type of work (sedentary, moderate, high activity, or strenuous), to analyze time lost from work after simultaneous compared with staged bilateral TKA. Results. We identified 152 employed patients who had undergone simultaneous bilateral TKA and 61 who had undergone staged bilateral TKA, and had completed the registry’s return to work questionnaire. The simultaneous group missed a mean of 46.2 days (SD 29.1) compared with the staged group who missed a mean total of 68.0 days of work (SD 46.1) when combining both operations. This difference was statistically significant (p < 0.001). In multivariate mixed regression analysis adjusted for age, sex, BMI, American Society of Anesthesiologists status, and type of work, the simultaneous group missed a mean of 16.9 (SD 5.7) fewer days of work compared with the staged group (95% confidence interval 5.8 to 28.1; p = 0.003). Conclusion. Employed patients undergoing simultaneous bilateral TKA missed a mean of 17 fewer days of work as a result of their surgical treatment and rehabilitation compared with those undergoing staged bilateral TKA. This information may be useful to surgeons counselling employed patients with bilateral OA of the knee who are considering surgical treatment. Cite this article: Bone Joint J 2021;103-B(6 Supple A):108–112

Introduction. Bilateral TKA is proven to be safe in a select group of patients. Patients with symptomatic bilateral knee arthritis who are not candidates for simultaneous bilateral TKA are subjected to staged surgery. The main objective of this study is to determine the safe window when second TKA can be performed in patients requiring bilateral TKA. Methods. Retrospective study includes bilateral TKA cases performed in a single institution between 2000–2018. A cohort of simultaneous bilateral TKA (n=2728) was compared to cohort of staged bilateral TKA (n=1660). Outcomes in terms of complications, reoperation, 30 days readmission and cumulative revision rates were compared between the two groups using both non-adjusted and adjusted models. Results. In-hospital complication rates were lower in the staged TKA group in both adjusted model (OR 0.59:0.48 – 0.72)(p <0.001), and unadjusted model (OR 0.54:0.47–0.63)(p<0.001). Although DVT rates were similar between both groups, odds of PE were higher in the simultaneous BTKA group (1.91% vs 0.54%)(p< 0.001). No statistically significant difference was found in reoperation rate between the groups both in the adjusted and unadjusted analyses. All causes revision rate in simultaneous TKA was significantly higher at 6.41% vs 2.35% for the staged TKA gr (OR 0.35 P<0.001). However, revision due to deep infection was higher in the staged group. No difference in complication rate after the 2. nd. surgery was detected when staging TKA was done less than 90 days apart compared to staging > 90 days (80.2% vs 79 %)(p=0.885). Conclusion. This single institution study demonstrates that bilateral TKA performed under the same anesthesia is associated with more complications and revisions than when compared to staged bilateral TKA. Furthermore, performing the second stage TKA under 90 days after the 1. st. TKA was not associated with more complications. Therefore performing simultaneous BTKA, simply for convenience, is not warranted

Introduction. A large proportion of patients undergoing total knee arthroplasty (TKA) have severe osteoarthritis in both knees and may consider either simultaneous or staged bilateral TKA. The implications of staged versus simultaneously bilateral TKA for return to work are not well understood. We hypothesized that employed patients who underwent simultaneous bilateral TKA would have significantly fewer days missed from work compared to the sum of days missed from each surgery for patients who underwent staged bilateral TKA. Methods. The prospective arthroplasty registry at Hospital for Special Surgery was utilized. We identified 61 employed patients who had undergone staged bilateral TKA and 152 employed patients who had undergone simultaneous bilateral TKA and had completed the registry's return to work questionnaire. Baseline characteristics and patient reported outcome scores were evaluated. We used a linear regression model, adjusting for potential confounders including age, sex, pre-op BMI, and work type (sedentary, moderate, high activity, or strenuous), to analyze workdays lost after staged versus simultaneous bilateral TKA. Results. Staged patients missed a mean total of 67.9±46.1 days of work across both TKA surgeries, compared to 46.5±29.0 days missed in the simultaneous group (p<0.001). In multivariate mixed regression analysis, adjusted for age, sex, BMI, ASA status, and work type, the staged group missed 16.9±5.7 more days of work compared to the simultaneous group (95%CI 5.8 to 28.1, p=0.003). Compared to sedentary work type, patients with high or strenuous work activity missed 19.4±9.4 (p=0.040) more total work days. Conclusions. Employed patients undergoing simultaneous bilateral TKA missed 17 fewer days of work over the course of their surgical treatment and rehabilitation compared to those undergoing staged bilateral TKA. This information may be useful to surgeons counseling patients with bilateral knee osteoarthritis about staged versus simultaneous bilateral surgery

Abstract. Introduction. Multiple strategies, used either in isolation or combination, are available to reduce the need for post-operative blood transfusion in joint replacements. Amongst them, the use of tranexamic acid (TXA) has been rising and this study was conducted to compare the efficacy of topical and intravenous TXA in bilateral total knee replacement patients. Materials and methods. Randomised prospective study with 120 patients (male: female: 25:95) undergoing bilateral TKA. Patients were divided into two groups A and B after computer randomization, who received intravenous or topical (intra-articular) TXA respectively. Results. The average haemoglobin loss in intravenous group was 90.2379 g/L as compared to 39.137 g/L in topical group (p < 0.005). Moreover, there was reduction in blood loss in topical (330.1602 ml) as compared to intravenous group (764.9622 ml). The blood transfusion rate was more for the intravenous group (average 1.73 units) than for the topical group (average 0.75, unit). WOMAC score at 6 weeks in the intravenous group was 12.50, and in the topical group was 7.23 (p value < 0.001). Conclusion. Topical TXA is better than intravenous TXA for reduction of blood loss, which also reduces the need for blood transfusion in bilateral TKA patients

Aims. The purpose of this study was to compare outcomes of combined total joint arthroplasty (TJA) (total hip arthroplasty (THA) and total knee arthroplasty (TKA) performed during the same admission) versus bilateral THA, bilateral TKA, single THA, and single TKA. Combined TJAs performed on the same day were compared with those staged within the same admission episode. Patients and Methods. Data from the National (Nationwide) Inpatient Sample recorded between 2005 and 2014 were used for this retrospective cohort study. Postoperative in-hospital complications, total costs, and discharge destination were reviewed. Logistic and linear regression were used to perform the statistical analyses. p-values less than 0.05 were considered statistically significant. Results. Combined TJA was associated with increased risk of deep vein thrombosis, prosthetic joint infection, irrigation and debridement procedures, revision arthroplasty, length of stay (LOS), and in-hospital costs compared with bilateral THA, bilateral TKA, single THA, and single TKA. Combined TJA performed on separate days of the same admission showed no statistically significant differences when compared with same-day combined TJA, but trended towards decreased total costs and total complications despite increased LOS. Conclusion. Combined TJA is associated with increased in-hospital complications, LOS, and costs. We do not recommend performing combined TJA during the same hospital stay. Cite this article: Bone Joint J 2019;101-B:573–581

Introduction. At a time when many surgeons are reluctant to perform a unilateral TKA in the obese patient, little is written on the safety and efficacy of bilateral simultaneous TKA in this same patient population. While these potential benefits are attractive to patients, surgeons may be hesitant to perform bilateral TKA due to the greater physical demand placed on the patient, and a potential increase in postoperative complication. The primary aim of this study was to analyze the impact of obesity on clinical outcomes and complication rates of patients undergoing bilateral TKA under one anesthetic. Materials and Methods. The clinical outcomes of 133 patients (266 knees) who underwent bilateral TKA between 2013 and 2016 were reviewed. The procedures were performed by three separate surgeons across three major academic institutions. ASA scores, tourniquet time, operative time, blood loss, length of stay, readmission, and postoperative complications were compared between different BMI categories of less than 30 kg/ m2, 30–34.99 kg/ m2, 35–39.99 kg/ m2and above 40 kg/ m2. Results. There were 83 females and 50 males who underwent bilateral TKA identified, with an average age of 60.17 years. The average LOS was 5 days and there was no significant impact of BMI on the length of stay or blood loss. 31 out of 133 patients experienced either a minor or major complication postoperatively (Table 1). Obese patients experienced more complications than non-obese patients. Specifically, patients identified as morbidly obese experienced a complication rate of 44.4%. This was significantly higher than the complication rate in the non-obese (less than 30 kg/ m2) patient cohort, 20.8% (p=.034). Of the 31 complications, 10 patients required a return to the operating room for a manipulation under anesthesia. There was no significant difference in the manipulation rate for the obese and non-obese patient. As BMI increased; postoperative ROM displayed a trend in the negative direction (Table 2). On average, obese patients had significantly higher ASA scores, with only 13.8% of patients with a BMI below 30 assigned an ASA score of 3 in comparison to 50% of patients with a BMI of 40 and above (p= .013) (Table 3). Higher BMI was significantly correlated with longer operative times (p=.002). Conclusion. Similar to numerous unilateral TKA studies in the obese patient, greater complication rates in the obese patient population were noted. The majority of complications that occurred within the time of this study were minor and did not affect the outcome of the procedure. Surgeons should carefully analyze the comorbidities of patients with a BMI above 40 kg/m2 such as cardiac history, diabetes mellitus, and smoking status when considering operating on morbidly obese patients and take steps to address these comorbidities and maximize the patient prior to surgery. For any figures or tables, please contact authors directly

Introduction. Bilateral total knee arthroplasty (TKA) can be performed under a single-anesthetic (SA) or staged under a two-anesthetic (TA) technique. Recently, our institution began piloting a two-surgeon team SA method for bilateral TKA. The purpose of this study was to compare the inpatient costs and clinical outcomes in the first 90 days after surgery between the team SA, single-surgeon SA, and single-surgeon TA approaches for bilateral TKA. Methods. All primary TKA performed from 2007–2017 by the two participating surgeons for each of the 3 groups of interest were identified: team SA (N=42 patients; 84 knees), single-surgeon SA (N=146 patients; 292 knees), single-surgeon TA (N=242 patients; 484 knees). No patients were lost to follow-up. Results. Median hospital cost (per TKA) for the episode(s) of care was as follows: team SA $20,962, single-surgeon SA $22,057, single-surgeon TA $31,145 (p<0.001 overall; p=0.0905 team SA vs single-surgeon SA). Rate of 90-day complications was 2.4% for team SA, 11.0% for single-surgeon SA, and 8.3% for single-surgeon TA (p=0.2090). Discharge to skilled nursing facilities or rehab was as follows: team SA 31%, single-surgeon SA 53% and single-surgeon TA after the second operation 34% (p<0.001). Conclusions. This pilot project suggests that team SA bilateral TKA is a potentially cost-effective option with fewer complications compared to single-surgeon SA bilateral TKA. The less frequent disposition to skilled nursing facilities in the team SA group in conjunction with more efficient OR utilization may further enhance the financial benefits

Aims. The aims of this study were to compare the efficacy of two agents, aspirin and warfarin, for the prevention of venous thromboembolism (VTE) after simultaneous bilateral total knee arthroplasty (SBTKA), and to elucidate the risk of VTE conferred by this procedure compared with unilateral TKA (UTKA). Patients and Methods. A retrospective, multi-institutional study was conducted on 18 951 patients, 3685 who underwent SBTKA and 15 266 who underwent UTKA, using aspirin or warfarin as VTE prophylaxis. Each patient was assigned an individualised baseline VTE risk score based on a system using the Nationwide Inpatient Sample. Symptomatic VTE, including pulmonary embolism (PE) and deep vein thrombosis (DVT), were identified in the first 90 days post-operatively. Statistical analyses were performed with logistic regression accounting for baseline VTE risk. Results. The adjusted incidence of PE following SBTKA was 1.0% (95% confidence interval (CI) 0.86 to 1.2) with aspirin and 2.2% (95% CI 2.0 to 2.4) with warfarin. Similarly, the adjusted incidence of VTE following SBTKA was 1.6% (95% CI 1.1 to 2.3) with aspirin and 2.5% (95% CI 1.9 to 3.3) with warfarin. The risk of PE and VTE were reduced by 66% (odds ratio (OR) 0.44, 95% CI 0.25 to 0.78) and 38% (OR 0.62, 95% CI 0.38 to 1.0), respectively, using aspirin. In addition, the risk of PE was 204% higher for patients undergoing SBTKA relative to those undergoing UTKA. For each ten-point increase in baseline VTE risk, the risk of PE increased by 25.5% for patients undergoing SBTKA compared with 10.5% for those undergoing UTKA. Patients with a history of myocardial infarction or peripheral vascular disease had the greatest increase in risk from undergoing SBTKA instead of UTKA. Conclusion. Aspirin is more effective than warfarin for the prevention of VTE following SBTKA, and serves as the more appropriate agent for VTE prophylaxis for patients in all risk categories. Furthermore, patients undergoing SBTKA are at a substantially increased risk of VTE, even more so for those with significant underlying risk factors. Patients should be informed about the risks associated with undergoing SBTKA. Cite this article: Bone Joint J 2018;100-B(1 Supple A):68–75

Aims. Distal femoral osteotomies (DFOs) are commonly used for the correction of valgus deformities and lateral compartment osteoarthritis. However, the impact of a DFO on subsequent total knee arthroplasty (TKA) function remains a subject of debate. Therefore, the purpose of this study was to determine the effect of a unilateral DFO on subsequent TKA function in patients with bilateral TKAs, using the contralateral knee as a self-matched control group. Methods. The inclusion criteria consisted of patients who underwent simultaneous or staged bilateral TKA after prior unilateral DFO between 1972 and 2023. The type of osteotomy performed, osteotomy hardware fixation, implanted TKA components, and revision rates were recorded. Postoperative outcomes including the Forgotten Joint Score-12 (FJS-12), Tegner Activity Scale score, and subjective knee preference were also obtained at final follow-up. Results. A total of 21 patients underwent bilateral TKA following unilateral DFO and were followed for a mean of 31.5 years (SD 11.1; 20.2 to 74.2) after DFO. The mean time from DFO to TKA conversion was 13.1 years (SD 9.7) with 13 (61.9%) of DFO knees converting to TKA more than ten years after DFO. There was no difference in arthroplasty implant systems employed in both the DFO-TKA and TKA-only knees (p > 0.999). At final follow-up, the mean FJS-12 of the DFO-TKA knee was 62.7 (SD 36.6), while for the TKA-only knee it was 65.6 (SD 34.7) (p = 0.328). In all, 80% of patients had no subjective knee preference or preferred their DFO-TKA knee. Three DFO-TKA knees and two TKA-only knees underwent subsequent revision following index arthroplasty at a mean of 12.8 years (SD 6.9) and 8.5 years (SD 3.8), respectively (p > 0.999). Conclusion. In this self-matched study, DFOs did not affect subsequent TKA function as clinical outcomes, subjective knee preference, and revision rates were similar in both the DFO-TKA and TKA-only knees at mean 32-year follow-up. Cite this article: Bone Jt Open 2024;5(11):1013–1019

Aims. The aim of this study was to describe and compare joint-specific and generic health-related quality of life outcomes of the first versus second knee in patients undergoing staged bilateral total knee arthroplasty (BTKA) for osteoarthritis. Methods. This retrospective cohort study used Australian national arthroplasty registry data from January 2013 to January 2021 to identify participants who underwent elective staged BTKA with six to 24 months between procedures. The primary outcome was Oxford Knee Score (OKS) at six months postoperatively for the first TKA compared to the second TKA, adjusted for age and sex. Secondary outcomes compared six-month EuroQol five-dimension five-level (EQ-5D-5L) domain scores, EQ-5D index scores, and the EQ visual analogue scale (EQ-VAS) between knees at six months postoperatively. Results. The cohort included 635 participants (1,270 primary procedures). Preoperative scores were worse in the first knee compared to the second for all instruments; however, comparing the first knee at six months postoperatively with the second knee at six months postoperatively, the mean between-knee difference was minimal for OKS (-0.8 points; 95% confidence interval (CI) -1.4 to -0.2), EQ-VAS (3.3; 95% CI 1.9 to 4.7), and EQ-5D index (0.09 points; 95% CI 0.07 to 0.12). Outcomes for the EQ-5D-5L domains ‘mobility’, ‘usual activities’, and ‘pain/discomfort’ were better following the second TKA. Conclusion. At six months postoperatively, there were no clinically meaningful differences between the first and second TKA in either the joint-specific or overall generic health-related quality of life outcomes. However, individual domain scores assessing mobility, pain, and usual activities were notably higher after the second TKA, likely reflecting the cumulative improvement in quality of life after both knees have been replaced. Cite this article: Bone Jt Open 2024;5(3):202–209

Aims. This study examined windswept deformity (WSD) of the knee, comparing prevalence and contributing factors in healthy and osteoarthritic (OA) cohorts. Methods. A case-control radiological study was undertaken comparing 500 healthy knees (250 adults) with a consecutive sample of 710 OA knees (355 adults) undergoing bilateral total knee arthroplasty. The mechanical hip-knee-ankle angle (mHKA), medial proximal tibial angle (MPTA), and lateral distal femoral angle (LDFA) were determined for each knee, and the arithmetic hip-knee-ankle angle (aHKA), joint line obliquity, and Coronal Plane Alignment of the Knee (CPAK) types were calculated. WSD was defined as a varus mHKA of < -2° in one limb and a valgus mHKA of > 2° in the contralateral limb. The primary outcome was the proportional difference in WSD prevalence between healthy and OA groups. Secondary outcomes were the proportional difference in WSD prevalence between constitutional varus and valgus CPAK types, and to explore associations between predefined variables and WSD within the OA group. Results. WSD was more prevalent in the OA group compared to the healthy group (7.9% vs 0.4%; p < 0.001, relative risk (RR) 19.8). There was a significant difference in means and variance between the mHKA of the healthy and OA groups (mean -1.3° (SD 2.3°) vs mean -3.8°(SD 6.6°) respectively; p < 0.001). No significant differences existed in MPTA and LDFA between the groups, with a minimal difference in aHKA (mean -0.9° healthy vs -0.5° OA; p < 0.001). Backwards logistic regression identified meniscectomy, rheumatoid arthritis, and osteotomy as predictors of WSD (odds ratio (OR) 4.1 (95% CI 1.7 to 10.0), p = 0.002; OR 11.9 (95% CI 1.3 to 89.3); p = 0.016; OR 41.6 (95% CI 5.4 to 432.9), p ≤ 0.001, respectively). Conclusion. This study found a 20-fold greater prevalence of WSD in OA populations. The development of WSD is associated with meniscectomy, rheumatoid arthritis, and osteotomy. These findings support WSD being mostly an acquired condition following skeletal maturity. Cite this article: Bone Jt Open 2024;5(10):879–885

Aims. The aim of this study was to determine whether closed suction drain (CSD) use influences recovery of quadriceps strength and to examine the effects of drain use on secondary outcomes: quadriceps activation, intra-articular effusion, bioelectrical measure of swelling, range of movement (ROM), pain, and wound healing complications. Patients and Methods. A total of 29 patients undergoing simultaneous bilateral total knee arthroplasty (TKA) were enrolled in a prospective, randomized blinded study. Patients were randomized to receive a CSD in one limb while the contralateral limb had the use of a subcutaneous drain (SCDRN) without the use of suction (‘sham drain’). Isometric quadriceps strength was collected as the primary outcome. Secondary outcomes consisted of quadriceps activation, intra-articular effusion measured via ultrasound, lower limb swelling measured with bioelectrical impendence and limb girth, knee ROM, and pain. Outcomes were assessed preoperatively and postoperatively at day two, two and six weeks, and three months. Differences between limbs were determined using paired Student’s t-tests or Wilcoxon’s signed-rank tests. Results. No significant differences were identified between limbs prior to surgery for the primary or secondary outcomes. No significant differences in quadriceps strength were seen between CSD and SCDRN limbs at postoperative day two (p = 0.09), two weeks (primary endpoint) (p = 0.7), six weeks (p = 0.3), or three months (p = 0.5). The secondary outcome of knee extension ROM was significantly greater in the CSD limb compared with the SCDRN (p = 0.01) at two weeks following surgery, but this difference was absent at all other intervals. Secondary outcomes of quadriceps activation, intra-articular effusion, lower limb swelling, and pain were not found to differ significantly at any timepoint following surgery. Conclusion. The use of CSD during TKA did not influence quadriceps strength, quadriceps activation, intra-articular effusion, lower limb swelling, ROM, or pain. These results have limited drain use by the authors in primary uncomplicated TKA. Cite this article: Bone Joint J 2019;101-B (7 Supple C):84–90

In a series of 1304 patients (1867 knees), the results of simultaneous and staged bilateral total knee arthroplasty were compared with each other and with unilateral total knee arthroplasty. The bilateral procedures had a significantly higher rate of complications than unilateral procedures, almost entirely because of thromboembolic problems. However, this did not correspond to an increase in mortality. If a bilateral procedure was indicated, then a simultaneous procedure had no increased risk over a staged procedure. There was no increase in cardiovascular complications, the rate of deep-vein thrombosis or pulmonary embolism or mortality. The rate of infection was lower with a bilateral procedure and the overall revision rate was less than 1% in all groups. The prosthesis functioned as well in all groups in the medium and longer term periods. We feel that simultaneous bilateral total knee arthroplasty is a safe and successful procedure when compared with a staged bilateral procedure. It also has the added benefit of single anaesthetic, reduced costs and decreased total recovery time when compared to a staged bilateral procedure. For these reasons it should be considered as an option in the presence of bilateral knee joint disease

In this paper, we will consider the current role of simultaneous-bilateral TKA. Based on available evidence, it is our opinion that simultaneous bilateral TKA carries a higher risk of morbidity and mortality and should be reserved for select few

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

Introduction. The ideal type of total knee arthroplasty (TKA) prosthesis remains a debatable topic with many different options available. Uncemented TKA has been a viable option due to its decreased operating room (OR) time but also because of its proposed improved long term fixation. Unfortunately, in the past uncemented TKA was associated with increased blood loss. Surgical technique and perioperative treatments have changed since these original studies and tranexamic acid (TXA) has become the gold standard for TKA blood loss management. The objective of this study was to evaluate if there was a difference in hemoglobin and hematocrit change, along with blood loss volume during surgery between cemented and cementless TKA when modern blood loss techniques are utilized. Methods. We retrospectively reviewed data from TKAs performed by three high volume surgeons between 2016 and 2019. We excluded bilateral TKA, revisions, hardware removal intraoperatively and other indications for TKA than primary OA. Power analysis determined 85 patients in both the cementless and cemented TKA groups. Patients were matched 1:1 for age, sex, BMI and surgeon. Use of TXA, intraoperative blood loss, differences in hemoglobin and hematocrit pre- and postoperatively days one, two, and three were recorded. Continuous variables were analyzed using T-tests and categorical variables were evaluated using Chi-squared tests. Results. No significant difference was observed between the cementless and cemented groups for hemoglobin (p=0.214), hematocrit (p=0.164), or intraoperative blood loss volume (p=0.343). A trend towards significantly shorter OR time was seen in the cementless group (p = 0.058). Conclusion. With modern TKA surgery, including the use of TXA, there is no difference in perioperative blood loss between cemented and cementless TKA. Unlike previous studies, the use of modern blood loss salvage techniques in conjunction with cementless TKA fixation, does not result in more blood loss during the perioperative period

Aims

The primary aim of this study was to compare the migration of the femoral and tibial components of the cementless rotating platform Attune and Low Contact Stress (LCS) total knee arthroplasty (TKA) designs, two years postoperatively, using radiostereometric analysis (RSA) in order to assess the risk of the development of aseptic loosening. A secondary aim was to compare clinical and patient-reported outcome measures (PROMs) between the designs.

Introduction. Closed suction intraarticular drain (CSD) use after total knee arthroplasty (TKA) has been studied with regards to wound healing and range of motion, however, no data exist on how CSD use impacts knee joint effusion and quadriceps strength. The primary purpose of this study was to determine whether CSD use influences recovery of quadriceps strength. Secondary outcomes examined effects of CSD on intraarticular effusion, lower limb swelling, knee range of motion (ROM), pain and wound healing complications. Methods. Twenty-nine patients undergoing same-day bilateral TKA were enrolled in a prospective, randomized blinded study. Subjects were randomized to receive a CSD on one lower extremity while the contralateral limb had the use of a subcutaneous drain (SCDRN) without the use of suction. Isometric quadriceps strength was collected as the primary outcome. Secondary outcomes consisted of quadriceps muscle activation, intraarticular effusion measured via ultrasound, lower extremity swelling measured with bioelectrical impendence, lower extremity girth, ROM, and pain. Outcomes were assessed preoperatively and postoperatively at day 2, 2 and 6 weeks and 3 months. Differences in limbs were determined using paired t-tests or Wilcoxon signed rank tests. Results. No significant differences were identified between limbs prior to surgery for the primary or secondary outcomes. No significant differences in quadriceps strength were seen between CSD and SCDRN limbs at postoperative day 2 (p = 0.09), two weeks (p=0.7), six weeks (p=0.3), or three months (p=0.5). Secondary outcomes, of quadriceps activation battery, intraarticular effusion, lower extremity swelling, ROM, and pain were not found to significantly differ at any time point following surgery. Conclusion. The use of CSD during TKA did not influence quadriceps strength, quadriceps activation, intraarticular effusion, bioelectrical measure of swelling, ROM, or pain. The results of this study have limited drain use by the authors in primary uncomplicated TKA

Aims

This study aims to determine difference in annual rate of early-onset (≤ 90 days) deep surgical site infection (SSI) following primary total knee arthroplasty (TKA) for osteoarthritis, and to identify risk factors that may be associated with infection.