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When the cartilage has worn away in both knees, an artificial knee (called a prosthesis) can take its place. The surgery to implant both of the prosthesis is termed a Bilateral Total Knee Replacement. Only the surface of the joint is removed - the arthritic ends of the bones are shaved off and replaced with new metal and plastic surfaces. The knee replacement recreates almost normal function of the knee, and its main goal is to relieve pain. It may also help to restore motion of both knees and straighten the limbs.
What is a Simultaneous Bilateral Total Knee Replacement?
A Simultaneous procedure means to replace both knees on the same day, under one anesthesia. This takes place in the same surgical event, within one hospital stay and is followed by a single rehabilitation period.
What is a Staged Bilateral Total Knee Replacement?
The Staged procedure means that both knee replacements take place as two separate surgical events. Surgeries are performed several months apart one from the other, requiring two hospital stays, two anesthesias and two rehabilitation periods.
What are the advantages of a Simultaneous Total Knee Replacement?
The advantages of having a Simultaneous procedure include: only one surgical event, single anesthesia, shorter overall hospital stay and the possibility of rehabilitating the patient symmetrically.
What are the advantages of a Staged Total Knee Replacement?
The advantages of having a Staged procedure include apparently lower stress level for the cardiovascular system, less complications related with the heart and the deep veins, as well as lower possibility of requiring banked blood after surgery. This is an excellent choice for a patients with cardiac, vascular or pulmonary diseases or above 80 years old.
What are the disadvantages of a Simultaneous Total Knee Replacement?
The disadvantages of having a Simultaneous procedure include a probable risk increase in cardiovascular complications and a higher possibility of requiring banked blood after surgery. This procedure is not available to every patient with problems in both knees, because it implies a high stress for the cardiovascular system. Only patients in a good health condition are appropriate candidates, and special emphasis should be made for an adequate patient selection. Also the initial rehabilitation is slightly more difficult as you lose "no good leg to stand on".
What are the disadvantages of a Staged Total Knee Replacement?
The disadvantages of having a Staged procedure include that it requires two hospital stays, two anesthesias and delays full return from disability.
Who should have a Bilateral Total Knee Replacement?
The most common reason for a Bilateral Total Knee Replacement is severe arthritic pain equally symptomatic in both knees, that interferes with the patient's activities of daily living and significant reduces the patient's quality of life. Usually complaints are worst with weight bearing activities, as standing and walking. Untreated, knee arthritis is usually painful, functionally limiting, it compromises the patient's independence and progresses over time. Another indication is several deformities in both knees, in which not correcting both knees deformities at the same time will compromise the clinical result.
Is there any contraindication for a Simultaneous procedure?
Yes. There are some contraindications and this is why we believe that the selection of the appropriate patient determines the outcome of the simultaneous procedure. The usual contraindications for Knee replacement include an active knee infection and severe neurologic compromise of the leg. This procedure is also relatively contraindicated in patients with concomitant cardiac, lungs and/or vascular disorders that may increase the possibilities of potential problems. Patients above 80 years old should not have a simultaneous procedure due to the risks that it involves.
Who would be the ideal candidate for a Simultaneous procedure?
The ideal candidate for a Simultaneous Total Knee Replacement should be younger than 80 years old, without associated cardiac, pulmonary or vascular diseases. This patient should also complain of severe arthritic pain equally symptomatic in both knees, that interferes with his/her activities of daily living and significantly reduces the his/her quality of life.
What are the results in terms of function and relieve of pain?
In both type of procedures, Simultaneous and Staged, results are excellent and equivalent in terms of relieve of pain and daily activities. Patients should expect a greater than 95% chance of success at 15 years.