DOS BULLETIN - Dansk Ortopædisk Selskab

2010-378_DOS nr. 3 2010 29/09/10 10:08 Side 74
Fast-track bilateral total knee arthroplasty
Henrik Husted, Anders Troelsen, Kristian Stahl Otte,
Billy B Kristensen, Gitte Holm, Henrik Kehlet
Dep. of orthopedics & Dep. of anaesthesiology, Hvidovre University
Hospital; Dep. of surgical pathophysiology, Rigshospitalet
Background: Bilateral simultaneous total knee arthroplasty (BSTKA) is
often found to be associated with increased morbidity and mortality.
Fast-track surgery (ANORAK-HH) has reduced length of stay (LOS) for
unilateral total knee arthroplasty, with high patient satisfaction and few
readmissions.
Purpose: Fast-track surgery may therefore also influence the potentially
increased morbidity and mortality associated with the bilateral simultaneous
procedure.
Methods: Inclusion criteria were symptomatic bilateral arthritis and
consent to BSTKA. Patients were not considered for the bilateral procedure
if they had a history of or objective findings indicating cardiopulmonary
disease. 150 patients (300 TKAs) were included, 87 were
female. For comparison, a group of unilaterally TKA operated patients
were found by registering data on the preceding and following patient
matched for gender (but not for age) operated nearest on the index operation
(BSTKA). Patients were subsequently excluded from comparative
analysis if they were operated with TKA in the contra lateral knee (=
staged bilateral TKA) during the study period. 271 patients thus registered
as a control group, 160 were female. Patients were followed for a
mean of 23.6 moths (SD 16.9) and a variety of parameters on outcome
were analyzed and compared.
Findings: Apart from staying longer (mean 4.7 days vs. 3.3 days) and
using more blood transfusions (45.6% vs. 12.1%); the outcome at 3
months and 2 years follow- up was identical or better in the bilateral
group regarding morbidity (complications), mortality, satisfaction, range
of motion, pain, use of walking aids, ability to return to work and ability
to perform activities of daily living.
Conclusion: Bilateral simultaneous total knee arthroplasty can be performed
in selected patients in a fast-track set-up with results comparable
to or better than unilateral total knee arthroplasty.
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