bilateral knee replacement
total knee replacement   Home Contact Us Site Map
 
M.S. ORTH (Pune),M.Sc., ORTH. (London) Dipl. LAMP (CARDIFF)
Consultant Joint Replacement Surgeon
www.jointreplacementexpert.com  
 
Profile Specialities Press Releases Client Testimonials Ask Your Doctor FAQ Photo Gallery
joint replacement consultant pune
knee arthritis, knee joint replacement
knee arthritis
total knee replacement
hip arthritis
total hip replacement
knee arthroscopy
orthopedic, knee joint replacement clinic
 
  Bilateral Total Knee Replacement
(Both Knee Joints-Total Knee Replacement)
 
One or both knees may be affected by arthritis. If both knee joints show changes on X-rays and only one knee joint is painful, stiff, and disturbs daily activities of life, then only the painful knee joint should be operated on. If both knees are equally painful, then both should be operated on.

The surgery that replaces both damaged knee joints is called bilateral total knee replacements.

Bilateral knee surgery is done routinely and it presents one of the most spectacular successes of the total knee replacement surgery.

This is so because two impaired knee joints cause much more symptoms and severe disability. In people with both knee joints affected, they have no healthy leg to rely on during the post operative rehabilitation!

Staged Total Knee Replacement
The surgeon replaces the arthritic knee joint one at a time, at two separate operations, often several days to several months apart. The patient will need two hospital stays, two anesthesia and two rehabilitation periods. This is called Staged Total Knee Replacement.

Simultaneous Bilateral Total Knee Replacement
If both knees are equally painful and stiff, it is possible to have both knees replaced during one operation under one anesthesia. The operations are followed by a single rehabilitation period within one hospital stay. Such two simultaneous surgeries are called Simultaneous Bilateral Total Knee Replacement or single sitting bilateral total knee replacement.
   
  Are the results of Simultaneous Total knee replacement equally good as the results of Staged Total knee replacement?
 


Both procedures produce equally good relief of pain and equally good return of function in the operated knees. The decision is based on the health status of the patient and is made in collaboration with the anesthetist.

   
  What are the advantages of a Simultaneous Total knee replacement?
 

The patient will have only one surgical "event", single anesthesia, and a shorter hospital stay.
 
  knee joint replacement expert pune
  What are the risks of a Simultaneous Total Knee replacement?
 


In comparison with staged procedure the risks with Simultaneous TKR are:

Three times increased risk of death during the 30 days period for people > 70 years (Parvizi, 2001)

Twice increased risk of complications, especially vascular complications such as deep vein thrombosis (Ritter 1997)

Much higher need (17 times) for banked blood with all possible complications (Lane 1997)

Three times increased risk of cardiopulmonary complications

Twice increased length of the stay at the intensive unit department

Twice increased need for prolonged rehabilitation

Higher rate of bone marrow emboli into the brain (Sulek 1999)

   
  What are the advantages of a Staged Total knee replacement ?
 


Lower stress on cardiovascular system, less complications, less risk for requiring allogenic (banked) blood.

 
  bilateral knee replacement india
  Who should have a Simultaneous Bilateral Total Knee replacement?
 

The ideal candidate is a patient under 70 years of age (some surgeons accept even older patients, up to 80 years), in good physical condition, without cardiac, pulmonary or vascular diseases. Such patients should also have severe pain in both knees that interferes with the activities of daily living. There should be signs of knee joint damage on X-ray pictures of both knees.

Because there are significant risks associated with Simultaneous Total knee replacement, a very careful evaluation of candidates is necessary. The patients should also be informed about the risks associated with this procedure.

  Should the X-ray changes of the other knee alone decide the bilateral operation?
 

If the patient has one bad knee and one good knee BUT both knees show X-ray signs of osteoarthritis, then should the patient have both knees replaced at once?

. The answer is No. Total knee replacement only of that knee joint which gives pain and
   stiffness is advisable.

. X ray findings should not dictate surgical decisions! It is important to discuss with the
   patient the pros and cons and thoroughly examine clinically before arriving at a decision.

. There is, however, a 75 % chance that the second symptomless knee (with apparent X-ray
   changes) will become painful during the next five years. However if that happens then a
   total knee replacement can always be done at that stage.
 
  Will the impairment of the other knee recede after operation on one side?
 

. If both knee joints have severe flexion deformity (knees that are stiff in bent position)

. In aged patients. In these patients a medical complication may develop and prevent the
   operation of the other knee. An elderly patient, who was suffering misery from bilateral
   knee impairment is able to function "normally" in 2 to 3 weeks after bilateral replacement.
   The state of depression of these patients often improves after their source of pain has
   been removed.

  Patients not suitable for TOTAL KNEE SURGERY
 

(of one or both knees)

. Patients with recent heart infarct and stroke
. Patients with uncontrolled diabetes, lung, kidney, or other systemic disease
. Patients with ongoing or recent infection in the knee joint area
. Patients with severe paralysis of muscles around the knee
. Patients with severe circulation problems (painful claudication) in the extremity.
. Patients with severe skin damage in the front of the knee joint
. Patients with open wounds in the lower leg.

  Other reasons why surgeons may advice against operation
 

Many surgeons will hesitate to carry out total knee replacement in

. badly motivated patients
. patients seeking financial or other gain from total knee surgery
. persons with alcohol abuse
. people with dementia (Mancuso 1996)

   
 
  bilateral knee replacement surgery
 
  « Previous
 
 
Copyright © 2010 All rights reserved.   Site powered by ikf.co.in