Introduction:
Total knee replacement (TKR) surgery has revolutionised the management of advanced knee arthritis, offering patients renewed mobility and relief from chronic pain, thereby improving the quality of life. When both knees require surgical intervention, the timing of bilateral TKR procedures becomes a critical consideration.
Two approaches have been considered, performing bilateral TKR in the same sitting or spacing the surgeries 48 hours apart. Both methods have their advantages and drawbacks, and understanding these factors is crucial for patients. The debate over performing both surgeries in the same sitting versus 48 hours apart continues to stir discussions among orthopaedic surgeons and patients alike.
Weighing Risks and benefits :
Bilateral total knee replacement offers relief to patients suffering from debilitating arthritis of both knees. Surgical planning in bilateral TKR is of priority for the benefit of postoperative rehabilitation and recovery.
In the same-sitting approach, both knees are replaced during a single operation and a single anaesthesia session. Performing bilateral TKR simultaneously offers the benefits of reduced hospitalisation time, and potentially faster overall recovery. By addressing both knees concurrently, patients undergo rehabilitation and regain function simultaneously, minimising the overall disruption to their daily lives. Additionally, simultaneous surgery may be cost-effective, as it reduces the need for extended hospital stay.
However, this method presents challenges like prolonged operative time, increasing the duration of anaesthesia. There is potentially increased risk of blood loss and postoperative complications, including thromboembolic events and delayed recovery.
Moreover, patients may experience greater postoperative pain and require more intensive postoperative care, including physical therapy and pain management strategies. The rehabilitation process may also be more demanding, as patients must contend with limitations in both lower extremities simultaneously.
In contrast, spacing bilateral TKR surgeries 48 hours apart, termed staged bilateral TKR, allows for a more gradual recovery process and may mitigate some of the risks associated with simultaneous surgery. By addressing each knee separately, the focus is on optimizing outcomes for each joint without the added complexity of managing both simultaneously. Staged procedures also reduce the overall operative time and potential intraoperative complications, enhancing patient safety. Patients may also benefit from reduced systemic stress and improved long term outcomes.
This approach has the benefits of less surgical time, less anaesthesia time and reduced intraoperative events. In addition, spacing the surgeries 48 hours apart allows for better management of pain and thereby optimises rehabilitation with good participation and cooperation from patients.
Significance of planning :
Ultimately, the choice between simultaneous and staged bilateral TKR depends on various factors, including patient preferences, medical comorbidities and surgical considerations. Surgeons must carefully weigh the risks and benefits of each approach and engage in shared decision-making with multidisciplinary approach to determine the most suitable course of action.
Regardless of the chosen method, the primary goal remains the same – to optimise patient outcomes and improve quality of life through effective management strategies. The holistic approach as a team with multidisciplinary approaches is the key to better outcomes of postoperative patients.
Dr. Mirunaalini Thangavelan
Dr. A. William Abraham
Dr. Vikraman