Bilateral total knee replacement under one anesthetic.

The postoperative results and complications among 41 patients undergoing bilateral total knee arthroplasty were compared with 40 patients who underwent unilateral total knee replacement. Among the bilateral group, the most common diagnosis was rheumatoid arthritis (68%), while degenerative arthritis prevailed in the unilateral group (50%). Preoperatively, patients in the bilateral group exhibited generally a greater degree of physical disability and limitation of activity due to multiple joint involvement. Postoperatively, no change in the arc of motion was noted in either group, although flexion contractures were significantly diminished in both. The degree of postoperative pain relief was identical in both groups as was the decreased need for walking devices. The most commonly observed complication among the unilateral group was prosthetic loosening (12.%). This was felt explainable on the basis of the increased postoperative activity level of patients with degenerative arthritis and single joint disease. Patients in the bilateral group showed a higher incidence of wound problems, presumably secondary to the long-term use of steroids. The infection rate was identical in each group, but the bilateral group displayed a higher incidence of pulmonary emboli (9.7 vs. 2.5%). The postoperative need for rehabilitation services and the duration of time before dependent walking was achieved was not prolonged in the bilateral group. Hospitalization of the bilateral group was increased only 20%. No deaths were reported in either group. When the need for total knee replacement exists bilaterally, bilateral replacement with a single anesthetic would appear reasonable, provided careful patient selection and technical guidelines are followed.