Comparison The Safety Of Unilateral And Simultaneous Bilateral Total Knee Arthroplasty

Objective:Simultaneous bilateral total knee arthroplasty is a surgical program of severe osteoarthritis of the knees, this treatment can save the cost of treatment, shorter hospital stays and recovery time, but due to a long operation time, severe trauma,safety of this surgical plan consistent suffered questioned. In this study, by collecting clinical data, comparing with the same period knees replacement knee replacement patient’s age, body mass index(BMI), Charlson comorbidity index(CCI), operative time, blood loss, drainage, blood transfusion, length of hospital stady and different time points serum inflammatory cytokines(IL-6, IL-10, TNF-α) concentration, we assess the safety of simultaneous bilateral total knee arthroplasty.Methods:We included 45 patients who underwent total knee arthroplasty at our institution between March 2014 and September 2014. All patients diagnosed as osteoarthritis.One side knee replacement were marked unilateral group, the same-day two sides knees replacement were marked bilateral group. We collected venous blood samples of each patient before surgery, and on postoperative hours 6, 24, 48 and 72. An enzyme-linked immunosorbent assay(ELISA) was used for determining the serum IL-6, IL-10, TNF-α. We statistics each patient’s age, body mass index(BMI),Charlson comorbidity index(CCI), operative time, blood loss, drainage, length of hospital stay, blood transfusion and other indicators, and contrast difference between the two groups.Results:At each time point, IL-10, TNF-α level in the blood of each group was no significant difference. IL-10, TNF-α in blood of both groups respectively reach the peak on postoperative hours 24 and 48. There were no signifant difference between the two groups in the IL-6 level in the blood sbefore surgery, and 48, 72 hours post-operation. Postoperation 6 and 24 hours, IL-6 concentrations in the blood of bilateral group were higher than the bilateral unilateral group, and the difference was statistically significance. IL-6 concentration of both groups reach the peak 6 hours postoperation, and then decreased gradually to the preoperative level. The average of Charlson comorbidity index(CCI), age were lower in bilateral group. Operative time,blood loss, postoperative drainage, length of hospital stay of bilateral group was higher than the unilateral group, the difference was statistically significant(P< 0.05).All patients with unilateral replacement surgery did not require blood transfusion, the average amount of blood transfusion of bilateral group was 570 ml. All included patients didn’t appear deep vein thrombosis, pulmonary embolism, periprosthetic infections, cardiovascular events, and other complications.Conclusions:Bilateral group occured more severe traumatic stress reactions than the unilateral group, but there were no postoperative adverse events. We believe that through a rigorous screening, younger, lower Charlson comorbidity index, less BMI patients underwent simultaneous bilateral total knee arthroplasty is safer.