Scientific Article   |    
Simultaneous Revision and Contralateral Primary Total Knee Arthroplasty
Hari P. Bezwada, MD; David G. Nazarian, MD; Robert E. BoothJr., MD
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Investigation performed at the Pennsylvania Hospital, Philadelphia, Pennsylvania

Hari P. Bezwada, MD
David G. Nazarian, MD
Robert E. Booth Jr., MD
Booth, Bartolozzi, Balderston Orthopaedics, Pennsylvania Hospital, 800 Spruce Street, Philadelphia, PA 19107. E-mail address for H.P. Bezwada: hbezwada@yahoo.com

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

J Bone Joint Surg Am, 2003 Oct 01;85(10):1993-1998
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Background: There is controversy regarding whether simultaneous or staged bilateral total knee arthroplasty should be performed in patients with bilateral gonarthrosis. In addition, revision total knee arthroplasties have been less successful than primary arthroplasties. The purpose of this study was to evaluate the results of simultaneous revision and contralateral primary total knee arthroplasties performed during the same setting.

Methods: The study cohort included 150 knees in seventy-five patients who had undergone revision arthroplasty because of aseptic failure of a total knee arthroplasty and a contralateral primary arthroplasty for severe gonarthrosis under the same anesthetic. The study group was compared with a control group of sixty patients who had severe arthritis in one knee and had undergone unilateral revision total knee arthroplasty on the contralateral side. The duration of follow-up averaged five years in the group treated with the simultaneous arthroplasties and eight years in the control group. Clinical and radiographic results were evaluated with the Knee Society rating system.

Results: In the study group, the average knee score improved by 48 points on the side of the primary arthroplasty and by 37 points on the side of the revision. At the last follow-up visit, most (sixty-five) of the seventy-five patients stated that the knee with the revision felt better than the knee with the simultaneously performed primary arthroplasty. In the control group, the average knee score improved by 30 points on the side of the revision arthroplasty. However, forty-five of the sixty patients had a primary total knee arthroplasty on the contralateral side within two years after the index revision arthroplasty; by four years, all sixty patients had undergone a contralateral primary arthroplasty.

Conclusions: We found a favorable outcome in patients who had undergone simultaneous revision and contralateral primary total knee arthroplasties. Despite a lower mean knee score and less motion, most patients seemed to prefer the knee with the revision arthroplasty to the knee with the primary procedure. These results suggest that this combined procedure is a safe and favorable alternative to a staged procedure consisting of revision and subsequent contralateral primary total knee arthroplasty.

Level of Evidence: Therapeutic study, Level III-2 (retrospective cohort study). See Instructions to Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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