Bilateral versus unilateral total knee replacement - comparison of clinical and functional results in two-year follow-up.

INTRODUCTION: Total knee replacement is one of the most common surgical methods in diagnosis of end staged osteoarthritis. In this retrospective analysis, we focus on comparison of functional and clinical outcome in patients undergoing unilateral and bilateral replacement within a single surgical procedure. METHODS: 54 patients (bilateral 19, unilateral 35) underwent total knee replacement in our clinic participated in the current study. The length of hospital stay was monitored in all patients. Assessment of functional results was based on the WOMAC score, KSS 1, KSS2, range of motion and presence of complications in both groups. RESULTS: Both groups of patients were homogeneous with age, body mass index and sex. The length of hospital stay in the unilateral group was 4.7±1.3 and 5.6±2.0 in the bilateral group. Patients operated on unilaterally achieved flexion of 114.9±9.3 after one year, bilateral group 112.6±8.6, the difference was insignificant. In both groups, there is a significant improvement one year postoperatively at WOMAC, KSS1 and KSS2. Comparing WOMAC, KSS1 and KSS2 between the unilateral and bilateral groups 3, 6, 12 months postoperatively, the differences are insignificant. The revision of implants in two-year follow-up reached 1.5% in unilateral group and 1.4% in bilateral group. CONCLUSION: Unilateral and bilateral knee joint endoprosthesis implantation is a successful surgical method in orthopedic practice. With conscious selection of patients, bilateral implantation may be more advantageous alternative, as the patient undergoes one operation and the associated risks.

[Bilateral Total Knee Arthroplasty. Short-Term Results]. / Bilaterálna implantácia TEP kolenného klbu ­ krátkodobé funkcné výsledky.

PURPOSE OF THE STUDY Evaluation of short-term functional results in patients undergoing one-stage surgery involving sequential bilateral total knee arthroplasty (TKA) and comparison with the results of patients after unilateral TKA. MATERIAL AND METHODS The group with bilateral TKA consisted of 171 patients with 342 total knee replacements treated between 2009 and 2013. The control group included 50 patients with 50 TKAs operated on in the years 2010 to 2012. The indications to bilateral knee replacement included bilateral gonarthrosis, grade III or more in patients who were in good health and had a stable knee joint with axis deviation up to 20 degrees. A cemented TKA was used and the posterior cruciate ligament was preserved. Assessment of functional results was based on the Womac score, Knee Society Score (KSS 1, 2) range of motion and presence of specific complications in both groups. The follow-up lasted three years. RESULTS The average results in the bilateral vs the control group were as follows: the Womac score, 39.4/42.2 pre-operatively, 87.2/71.0 at 3 years; KSS 1, 48.5 / 44.8 pre-operatively, 87.4 / 79.9 at 3 years; KSS 2, 44.1 / 50.6 pre-operatively, 86.1 / 72.8 at 3 years; motion-flexion, 105.2° / 105.7° preoperatively, 114.0° / 100.2° at 3 years. In the bilateral group, infection was recorded in one patient. DISCUSSION Bilateral total knee replacement is a controversial issue. A higher risk of non-specific complications has been reported. Functional outcomes are good. The key problem is to set the correct indication to this procedure after an individual assessment of the patient's general health condition and the state of his/her knee joints. CONCLUSIONS The patients undergoing bilateral TKA at one-stage surgery showed functional results comparable (range of motion was even better) with the results of the unilateral TKA group. The number of specific complications was low. Every patient should be carefully assessed. Key words: total knee arthroplasty, bilateral implantation, functional results.