Abstract
Bilateral simultaneous total knee replacement surgery remains controversial with arguments for and against its use. Doing sequentially staged TKR's is a safer procedure and may have additional benefits as set out below.
If both knees need to be replaced we have often seen that the symptoms of the contralateral knee improve after the one knee is replaced and that patients wait some time before having the opposite knee replaced.
Materials:
333 of 2084 patients having primary total knee replacements needing bilateral replacements were reviewed retrospectively.
Results.
245 patients were seen initially with bilateral arthritis of the knee and needed bilateral TKR, while 88 patients developed arthritis in the contralateral knee following TKR.
No patients had simultaneous bilateral TKR's; operations were done sequentially and the average time between the TKRs was 20.77 months with a range between 1.5–111 months.
Most patients had the contralateral knee replaced within two years of the first knee replacement but 81 patients actually waited between 2 and 10 years before coming in for the second TKR.
Conclusion:
It is possible to wait some time before it becomes necessary to replace the contralateral knee in patients who need bilateral TKRs and avoid the increased risk of bilateral simultaneous surgery. The delay not only reduces the cost for the first operation but also gives the second knee a longer time to failure. This is especially important in the typical patients who qualify for bilateral simultaneous TKR's i.e. the younger fitter patients.
