Total endoprosthetic replacement of hip and knee joints in patients with degenerative or inflammatory disease is a reliable treatment in orthopedic surgery since many years. However patients with oligo- or polyarticular disease are still a problem because of several operations within repeated periods of hospitalisation. Patients who need multiple joint replacements reject surgical procedures considering long time of suffering and hospitalisation by being treated in following one step after the other. Offering simultaneous surgery in two joints is often a probate opportunity to avoid this problem. To resolve this problem we decided one stage procedure in selected cases.
Between 01. 01. 99 and 31. 12. 01 we supplied 57 patients with 2 endoprosthesis (hip or knee) in one single surgical procedure. In 26 cases we implanted total hip replacement bilateral. 11 patients were female and 15 patients were male. The age differed between 26 and 73 years with an average of 64 years. One patient got hybridendoprosthesis (Muenchner socket/MEM stem). The others got a cementless model (Fitek or ACA socket/Weill or Spotorno stem). The average time of hospitalisation was 23, 5 days. In 3 cases allogenic packed human bloodcells (up to 960 ml in one case) were necessary. The mean time of operation was 142 min. In 25 cases we did total knee alloarthroplasty on both sides. 17 patients received all cemented Wallaby-I knees and 1 patient received all cemented PFC prosthesis. 7 patients got got an all cemented Scorpio knee prsthesis. 14 of these patients were female and 11 patients were male. The age differed between 35 and 75 years with an average of 66. The average time of hospitalisation was 21, 5 days and the average time of operation took 123 min. Allogenic packed human bloodcells were not necessary in any case. In 6 cases we did total alloarthroplasty on knee and hip simultaneous. All patients received all cemented Wallaby-I knees and different cementless or hybrid-hip-prosthesis (Fitek or ACA socket/MEM, Weill or Spotorno stem). 4 of these patients were female and 2 patients were male. The age differed between 39 and 79 years with anaverage of 61. The average time of hospitalisation was 24, 5 days. The mean time of operation was 132 min. Transfusion of allogenic packed human blood-cells was necessary in one case. By standard all patients underwent praeoperative blood donation and postoperative autologous retransfusion (mean 640 ml) within 6 hours. In four cases we saw an increase of the inflammatory test results one week postoperative, which we treated with Tavanic 500 1 - 0 - 0 orally. Other complications didn′t occur. All patients were able to leave the hospital with full weight bearing.
Compared to single hip joint replacement the average time of hospitalisation was only 4, 1 days longer, in case of simultaneous knee replacement we saw an increase of 3, 3 days. Considering the high acceptance due to the above mentioned advantages we recomand simultaneous replacement of two joints as an approbiate procedure in patients suffering from multiple joint destructions.
