2017 ISAKOS Biennial Congress ePoster #1240

 

Bilateral Simultaneous Fixed-Bearing Unicompartmental Knee Arthroplasty (UKA): A Safe and Efficient Technique

Jawad Sultan, MBBS, MSc, MRCS, FRCS (Tr & Orth), Bolton, Greater Manchester UNITED KINGDOM
Alison Winter, BSc, MBBS, MRCS, FRCS (Tr & Orth), Harrogate, North Yorkshire UNITED KINGDOM
Kathryn Mason, ODP, ASP, Harrogate, North Yorkshire UNITED KINGDOM
Nick London, MA, MD, FRCS (Tr & Orth), Wetherby, North Yorkshire UNITED KINGDOM

Harrogate and District NHS Foundation Trust, Harrogate, North Yorkshire, UNITED KINGDOM

FDA Status Not Applicable

Summary

In our cohort of patients; bilateral simultaneous fixed-bearing UKA was a well-tolerated procedure with outcomes superior to the national average. Length of stay and surgical time were longer but remain favourable when compared to the sum of staged procedures. This two-surgeon technique provides a safe and efficient pathway for managing patients with bilateral disease.

Abstract

Introduction

Bilateral simultaneous UKA remains controversial due to concerns around higher perioperative complication rates and more difficult postoperative recovery. The majority of the literature presents outcomes of bilateral UKA done sequentially under the same anaesthetic. In this study we assess the outcomes of bilateral fixed-bearing UKA performed simultaneously by two surgeons (one consultant and one trainee). We hypothesised that patient satisfaction and survivorship would be unaffected, but that surgical time and length of stay would be increased compared to unilateral UKA.

Methods

We report on 160 knees in 80 sequential patients. Patient reported outcome measures (Oxford Knee Score 0-48) were collected. Surgical demographics, complications and implant survivorship were recorded. Data was compared with published National Joint Registry (NJR) outcomes and departmental surgical demographic data for unilateral UKA.

Results

80 patients with an average age of 65.7 (range 50-83) underwent bilateral UKA over a 15-year period. Mean surgical time was 81 minutes (range 56-105 minutes). This was a 36% increase compared to surgical time for a single UKA in our department. The large range reflects the varying surgical experience of the knee fellows (trainees) during the study. Mean length of stay following bilateral UKA was 3.5 days (range 2-6 days), 40% longer than our average length of post-operative stay for unilateral UKA. Complication rates were extremely low with one pulmonary embolus reported and successfully treated. There were no early deaths or deep infections in the cohort of patients. At mean 6.73 years (range 2-15 years) follow up, the survivorship was 96% with 5 knees requiring revision. Two knees were revised for aseptic loosening, the others for progression of disease. This revision rate compares favourably with the NJR data on survivorship. On questioning, 90% of patients would recommend the bilateral procedure to a friend. Excellent outcome measures were recorded, with a median Oxford knee score of 43 (range 29-48) at one year. This compares favourably to the NJR data where a median score of 38 is reported.

Conclusions

In our cohort of patients; bilateral simultaneous fixed-bearing UKA was a well-tolerated procedure with outcomes superior to the national average. Length of stay and surgical time were longer but remain favourable when compared to the sum of staged procedures. This two-surgeon technique provides a safe and efficient pathway for managing patients with bilateral disease.