Introduction: Morbidity and mortality are major concerns after simultaneous bilateral TKA. This paper reviews the results of patients who had simultaneous bilateral TKA (558 patients) and compares it to the results of single TKA (485 patients) carried out by the same surgeon in the same institution using same intra operative and post operative protocols.

Material and methods: 558 patients underwent simultaneous bilateral TKA while 485 underwent single TKA carried out by the same surgeon. The pre-op medical evaluation was carried out by a special multidisciplinary medical team. The decision to proceed with simultaneous TKA was made based on the clinical findings pre operatively. There were no additional special cares for the simultaneous group (central or arterial line) during surgery. Post op protocols were the same for both groups

Results: Blood transfusion was higher in the simultaneous knee surgeries (71%) as compared to (34 %) in a single knee group. We had 8 unscheduled ICU admission in the simultaneous group compared to 2 in the individual. Surprisingly DVT was less common in the simultaneous group. We had one death in the simultaneous group. The average knee score and average range of motion were the same in both groups.

Discussion and conclusion: Simultaneous bilateral TKA is safe. It is more economical and convenient, especially for patients who travel for the surgery. A special multidisciplinary task force is recommended to make the simultaneous knee surgery safe.

The majority of implants available in the market today were designed to allow for a flexion up to 130 degree angle. The LPS Mobile Flex was designed to accommodate deep flexion, up to 160 degree angle. The purpose of this study is to evaluate the clinical result of the LPS Mobile Flex knee.

From January 1999 to February 2004, 635 surgeries were performed on patients treated for advance osteoporosis. All the surgeries were carried out by the same surgeon. The majority of the patients had bilateral total knee replacements simultaneously. Pre-operative ranges of motion were documented on lateral x-ray. Patients were considered to have full flexion if they were able to fix the knee to at least 140 degree angle sit on the ground with calf touching thigh for at least one minute.

68% obtained full flexion as defined above. The majority of the cases with full flexion had full movement pre-operatively, except for 26 cases. Some omplications were reported. There were 2 cases of personal nerve palsy, three of dislocation, and one of infection. There was also a case of rupture of MCL ligament, a case of intra-operative tibial plateau fracture and one of upra-condyler femur fracture. No revision was performed. There were no patella complications

The LPS Flex Implant had a similar complication rate to those reported by other series. There was no complication that could be specifically attributed to deep flexion. Surprisingly, there were no patella complications and the implant, in general, had an excellent clinical outcome as far as mobility. However, it should be stressed that this exceptional result has to do mainly with careful patient selection.