Unilateral versus simultaneous bilateral total knee arthroplasty: A comparative study.

OBJECTIVE: To compare pre-operative characteristics and peri-operative findings in patients undergoing unilateral total knee arthroplasty (UTKA) and simultaneous bilateral total knee arthroplasty (BTKA). To work out safety criterion for selection of patients for simultaneous BTKA. METHODS: Patients undergoing UTKA (39) and BTKA (36) in Department of Orthopaedic Surgery, Combined Military Hospital, Rawalpindi from March 2014 to August 2014 were compared in terms of patient characteristics, underlying pathology, peri-operative blood loss, transfusion requirements and in hospital complications. RESULTS: The mean age of patients undergoing UTKA was 61±11 years and those undergoing BTKA was 64±8 years, with similar male to female ratio (1:1.8) in both groups. Males undergoing BTKA were significantly older than other patients (71±6 years). Primary osteoarthritis was the most common initial diagnosis (59% in UTKA and 89% in BTKA, p<0.05) followed by rheumatoid arthritis. Average blood loss per knee was higher in BTKA procedures but difference did not reach statistical significance. Blood transfusion requirements in BTKA patients not receiving antifibrinolytic agent were significantly higher than in similar UTKA patients (75% vs 17%, p<0.05) but were significantly reduced with peri-operative administration of antifibrolytic therapy (30% BTKA, p<0.05). Complication rates, low in both, were more frequent in BTKA patients with co-morbidities. CONCLUSIONS: In patients requiring bilateral knee replacements, staged total knee replacement [i.e. the two knees are replaced with a gap of at least 3 months] is a safe approach. Unilateral knee replacement is associated with lesser complications and blood transfusion requirements as compared to simultaneous bilateral total knee replacements.

Early release of tourniquet in total knee arthroplasty: Is it worthwhile?

OBJECTIVE: To compare the effects of duration and timing of tourniquet release on perioperative blood loss, transfusion requirement, duration of surgery, length of hospital stay and early complications in total knee arthroplastywith and without additional anti-fibrinolytic therapy. METHODS: The prospective quasi-experimental study was conducted at the Combined Military Hospital, Rawalpindi, from March to August 2014. The patients undergoing total knee arthroplasty were divided into two groups: in Group A tourniquet was released after closure of surgical wound and applying compressive dressing; and in Group-B tourniquet was deflated after cementation of implants following which closure was done. Each group was further divided into those who received tranexamic acid (A-T, B-T) and those who did not (A-C, B-C). Study variables were noted on a proforma and analysed. RESULTS: Of the 75 patients in the study, 27(36%) were male and 48(64%) were females. Calculated blood loss was 408mL and 422mL in group A-T and B-T respectively (p=0.73), and 615mL and 610mL in group A-C and B-C respectively (p=0.95). Tourniquet time was significantly shorter (p<0.0005) in group B whereas duration of surgery was significantly shorter (p<0.0001) in group A (68±9min vs 77±11min). Transfusion frequency was higher in group B. Complication rate in the two main groups was not significantly different (p=0.314). Mean length of hospital stay was not significantly different (p>0.05). CONCLUSIONS: Earlier intra-operative release of tourniquet in patients undergoing total knee arthroplasty was associated with increased surgery time and higher frequency of blood transfusion without conferring any significant benefit.