Morbidity of Sequential Bilateral Revision TKA Performed Under a Single Anesthetic

There are little data reporting perioperative morbidity and postoperative complications of bilateral sequential revision total knee arthroplasties (TKAs) performed in one anesthetic setting. We retrospectively reviewed 49 patients undergoing 51 complete (tibial and femoral components) bilateral revision TKAs under a single anesthetic between 1999 and 2006. The average age was 65 years; the minimum followup was 1 month (average, 12 months; range, 1-38 months). Comorbidities included cardiovascular (n = 32), pulmonary (n = 13), endocrine (n = 22), gastrointestinal (n = 30), and neurologic (n = 18). Average surgical time was 64 minutes per limb. Six patients received no stems, six received two stems, two patients received three stems, and 37 received four stems. We encountered no intraoperative complications and no patients with postoperative cardiovascular compromise, stroke, or death. Postoperative complications included confusion in three patients, one pulmonary embolism treated successfully with extended anticoagulation, one patient with posterior compartment syndrome treated with fasciotomy, and one with bilateral stiffness who underwent manipulation under anesthesia at 3 months. In our patients the perioperative medical risks of bilateral TKA performed under a single anesthetic were low, even with the use of stemmed components.

Level of Evidence: Level IV, therapeutic study. See the Guide-lines for Authors for a complete description of levels of evidence.