Simultaneous bilateral versus unilateral total knee arthroplasty in treatment of knee osteoarthritis

doi:10.3969/j.issn.2095-4344.2014.35.002

Abstract

Abstract:

BACKGROUND: The safety and efficacy of simultaneous bilateral total knee replacement or selective unilateral total knee arthroplasty in patients with severe osteoarthritis of the knees are still controversial.
OBJECTIVE: To compare safety and clinical efficacy of patients with osteoarthritis knees after simultaneous bilateral total knee replacement or selective unilateral total knee replacement.
METHODS: Totally 60 cases with severe osteoarthritis of the knees (90 knees) undergoing total knee replacement were divided into unilateral total knee replacement group (n=30, 30 knees), and the simultaneous bilateral total knee replacement group (n=30, 60 knees).
RESULTS AND CONCLUSION: There was no significant difference in the incidence of other complications such as infection, mortality, pulmonary embolism in patients of both groups (P > 0.05). The incidence of cardiovascular complications, postoperative blood loss and blood transfusion were higher in the bilateral knee group than in the unilateral knee group (P < 0.05). During follow-up at 1 year after replacement, no significant differences in range of motion, muscle strength of quadriceps and hospital for special surgery knee score were detected in patients of both groups (P > 0.05). However, Visual Analogue Scale scores were significantly lower in the bilateral knee group than in the unilateral group (P < 0.05). These data indicated that the risk of cardiovascular complications was high in patients receiving bilateral total knee replacement. Patients with severe cardiovascular disease should avoid simultaneous bilateral total knee arthroplasty.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: arthroplasty, replacement, arthroplasty, replacement, knee, osteoarthritis, osteoarthritis, knee, postoperative complications

CLC Number:

R318

Ye Chuan, Liu Ri-guang, Tang Jin, Li Jiang-wei, Zhang Tao, Ren Hou-xiang, Sun Qi, Wu Cheng, Zhao Bao-ping . Simultaneous bilateral versus unilateral total knee arthroplasty in treatment of knee osteoarthritis[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(35): 5583-5588.

Figures/Tables 1

2.1 膝骨性关节炎双侧同期全膝关节置换和单侧膝关节置换患者的数量分析及一般资料所有患者均获随访，随访12-24个月。双膝组与单膝组患者年龄、性别和体质量指数比较差异无显著性意义(P > 0.05；表1)。 2.2 膝骨性关节炎双侧同期全膝关节置换和单侧膝关节置换患者置换前后合并症变化在60例患者中，有33例(55%)存在合并一种或多种内科疾病，其中单膝组16例(27%)，双膝组17例(28%)，2组患者置换前合并症患病率的比较差异无显著性意义(P > 0.05；表2)。共有20例患者出现置换后并发症，其中单膝组9例(30%)，双膝组11例(37%)，2组比较差异无显著性意义(P > 0.05)。但单膝组患者置换后出现心血管系统疾病的占10%，而双膝组则高达20%，明显高于单膝组(P < 0.05)。2组患者置换后出现呼吸系统、神经系统、消化系统、泌尿系统、切口感染、下肢深静脉栓塞、肺栓塞、死亡的比例差异无显著性意义(P > 0.05；表3)。 2.3 膝骨性关节炎双侧同期全膝关节置换和单侧膝关节置换患者血液学指标的差异 2组患者置换前血红蛋白水平差异无显著性意义(P > 0.05)，但双膝组患者置换后血红蛋白水平、失血量和输血量均高于单膝组(P < 0.05，表4)。 2.4 膝骨性关节炎双侧同期全膝关节置换和单侧膝关节置换患者的临床疗效 2组患者置换后1年随访时的膝关节活动度、目测类比评分、股四头肌肌力和美国特种外科医院膝关节评分较置换前均有明显改善(P < 0.05)，而2组患者膝关节活动度、股四头肌肌力和美国特种外科医院膝关节评分的差异无显著性意义(P > 0.05)，但单膝组患者目测类比评分明显高于双膝组(P < 0.05；表5)。影像学检查显示2组患者均未出现假体松动和移位(图1)。"

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