title: Simultaneous bilateral total knee replacement: a prospective study of 150 patients.
abstract: OBJECTIVE
  To evaluate the safety of simultaneous bilateral total knee replacement (TKR).
  
  
  METHODS
  124 women and 26 men (mean age, 66 years) underwent simultaneous bilateral TKR for tricompartmental osteoarthritis using a posteriorstabilised, high-flexion implant. All patients underwent dobutamine stress echocardiography for detection of any silent cardiac comorbidity by a cardiologist. None had any adverse effect after testing. Five patients had positive outcome and underwent coronary angiography to detect any significant coronary blockage. Functional outcome was evaluated using the Knee Society Score (KSS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC). Tranexamic acid was given intravenously to reduce peri-operative blood loss. Femoral blocks and patient-controlled analgesia were used to facilitate early recovery. Aggressive physiotherapy was allowed. Patients were followed up at months 3, 6, and 12, and yearly thereafter.
  
  
  RESULTS
  At the 2-year follow-up, the mean range of motion improved from 95º to 129º (p=0.032), the mean KSS from 120 to 158 (p<0.001), and the WOMAC from 51 to 88 (p=0.002). One patient developed patellar crepitus at week 6, which resolved with conservative treatment. Another patient developed infection in both knees at month 6. Despite salvage procedures, infection recurred after 3 months and the patient underwent bilateral arthrodesis. No patient developed deep vein thrombosis or pulmonary embolism, myocardial infarction, atrial fibrillation, or other cardiac event.
  
  
  CONCLUSIONS
  Simultaneous bilateral TKR is safe for properly selected patients.
authors: Dr LH Hiranandani Hospital, Mumbai, India. drsanjain@gmail.com
authors: Sanjeev
authors: S
authors: Jain
authors: Sandeep
authors: S
authors: Wasnik
authors: Amber
authors: A
authors: Mittal
authors: Sameep
authors: S
authors: Sohoni
authors: Sarang
authors: S
authors: Kasture
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D013997:Time Factors
keywords: arthroplasty, replacement, knee; dobutamine; echocardiography, stress