Safety of simultaneous bilateral total knee arthroplasty using an extramedullary referencing system: results from 2098 consecutive patients.
BACKGROUND
Simultaneous bilateral total knee arthroplasty (TKA) has been associated with a high risk of morbidity and mortality. The orthopedic surgeon must, therefore, decide whether bilateral simultaneous TKA is a safe operation to perform and endeavor to decrease the risk of serious complications or even death.


METHODS
This retrospective review included 2098 consecutive patients who underwent bilateral simultaneous TKAs by the protocol used in our institution, including the use of extramedullary instruments to minimize medullary canal invasion and overlapping procedures for both knees to decrease operation time.


RESULTS
The incidence rate of occurred complications was 0.33 % for symptomatic pulmonary embolism, 0.62 % for deep surgical infection requiring revision surgery, 0.05 % for 14-day mortality, 1.14 % for adverse cardiac events, and 0.76 % for postsurgical delirium within the 1-year follow-up.


CONCLUSIONS
Our protocols, including the use of an extramedullary referencing system and overlapping procedures for both knees, may be considered to decrease the perioperative short-term morbidity and 14-day mortality rates in simultaneous bilateral TKA.
Department of Orthopedic Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea.
Jai Gon
JG
Seo
Seoul Medical Center, Sinnae 1-dong, Jungnang-gu, Seoul, Korea.
Sang Min
SM
Kim
Hanyang Medical Center, Hanyang University School of Medicine, Seoul, Korea.
Jung Min
JM
Shin
Center for Bionics, Korea Institute of Science and Technology, Seoul, South Korea.
Youngjun
Y
Kim
Department of Orthopedic Surgery, Kang-Dong Sacred Heart Hospital, Hallym University Medical School, 134-701, Gil-dong, Seoul, Korea. oselite@naver.com.
Byung Hoon
BH
Lee
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology*; D012086:Reoperation; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends
Complication; Mortality; Simultaneous bilateral; Total knee arthroplasty