Two-surgeon simultaneous bilateral total knee arthroplasty does not provide poor prosthetic alignment A prospective randomized controlled study

Abstract

Purpose Two-surgeon, simultaneous bilateral total knee arthroplasty (TKA) is considered as an unpredictable, complex procedure in terms of its radiographic and functional outcomes because of different surgeons and teams, and too many instruments and hands in a narrow space. We compared radiological and functional results of simultaneous bilateral TKA and single-surgeon sequential bilateral TKA. Methods The 136 participants with a minimum of 24 months follow-up were prospectively randomized into 2 groups: two-surgeon bilateral TKA and single-surgeon bilateral TKA. We prespecified primary outcome of the study as between-group differences in terms of component alignment in the coronal and sagittal planes. Short-term functional outcomes were evaluated prospectively using the Oxford Knee Score (OKS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Results Each group consisted of 136 knees of 68 patients. The mean tibial medial angles (TMA) were 89 degrees +/- 3 degrees and 88 degrees +/- 5 degrees in two-surgeons and single surgeon groups, respectively (p = 0.24). Radiological outcomes showed that the mean femoral lateral angles (FLA) were 87.9 +/- 3.5 degrees and 85.84 +/- 3.7 degrees (p = 0.12), posterior tibial slope angles (PTSA) were 8.2 +/- 16.9 degrees and 7.6 +/- 17.8 degrees (p = 0.84), and femoral flexion angles (FFA)were 86.8 +/- 3.8 degrees and 86.3 +/- 3.5 degrees (p = 0.41), anterior femoral offset ratios (AFOR) (%) were 29.5 +/- 11.1 and 27.7 +/- 7.9 (p = 0.31), and posterior femoral offset ratio (PFOR) (%) were 108.41 +/- 31.3 and 108.45 +/- 25.7 (p = 0.98), respectively. Conclusion Two-team simultaneous bilateral TKA is as safe as single stage one-surgeon sequential bilateral TKA in terms of short-term component radiological and the functional outcomes.