Prevalence of Nerve Injuries in Lower Limb following Total Joint Replacement Surgery, and Management

Vol 3 | Issue 2 |  July-Dec 2018 | Page 36-43 | Kunal Ajitkumar Shah, Mohan M Desai.

Authors: Kunal Ajitkumar Shah [1], Mohan M Desai [1].

[1] Department of Orthopaedics, KEM Hospital, Parel Mumbai

Address of Correspondence
Dr. Mohan Desai,
Department of Orthopaedics, KEM Hospital, Parel Mumbai


Nerve injuries during lower limb joint replacement are uncommon but serious complications. Review of this condition is sparse in literature. The present review aims to collate the current literature and provide an overview of the subject. Subclinical cases are quite common and preoperative counseling would be helpful. In case the nerve injury occurs, assurance and counselling helps. Since, the prognosis is not uniform and depends on multiple factors, it is best to try and avoid these iatrogenic injuries. A good surgeon knows how to manage his complications, but the best surgeon knows how to avoid them!
Keywords: Nerve injuries, knee arthroplasty, hip arthroplasty, iatrogenic


1. Ahmad I, Patil S. Isolated deep peroneal (fibular) nerve palsy in association with primary total hip arthroplasty. Clin Anat 2007;20:703–4.
2. Brown GD, Swanson EA, Nercessian OA. Neurologic injuries after total hip arthroplasty. Am J Orthop (Belle Mead NJ) 2008;37:191–7.
3. Farrell CM, Springer BD, Haidukewych GJ, Morrey BF. Motor nerve palsy following primary total hip arthroplasty. J Bone Joint Surg Am 2005;87:2619–25.
4. Navarro R. Surgical Approach and Nerve Palsy in Total. J Arthroplasty 1995;10:1–5.
5. Nercessian OA, Piccoluga F, Eftekhar NS. Postoperative sciatic and femoral nerve palsy with reference to leg lengthening and medialization/lateralization of the hip joint following total hip arthroplasty. Clin Orthop Relat Res 1994:165–71.
6. Edwards BN, Tullos HS, Noble PC. Contributory factors and etiology of sciatic nerve palsy in total hip arthroplasty. Clin Orthop Relat Res 1987:136–41.
7. Idusuyi OB, Morrey BF. Peroneal nerve palsy after total knee arthroplasty. J Bone Jt Surg 1996;78:177–84.
8. Asp JP, Rand JA. Peroneal nerve palsy after total knee arthroplasty. Clin Orthop Relat Res 1990:233–7.
9. Rose HA, Hood RW, Otis JC, Ranawat CS, Insall JN. Peroneal-nerve palsy following total knee arthroplasty. A review of The Hospital for Special Surgery experience. J Bone Joint Surg Am 1982;64:347–51.
10. Horlocker TT, Cabanela ME, Wedel DJ. Does postoperative epidural analgesia increase the risk of peroneal nerve palsy after total knee arthroplasty? Anesth Analg 1994;79:495–500.
11. Coventry MB, Upshaw JE, Riley LH, Finerman GA, Turner RH. Geometric total knee arthroplasty. II. Patient data and complications. Clin Orthop Relat Res n.d.:177–84.
12. Park JH, Hozack B, Kim P, Norton R, Mandel S. Common Peroneal Nerve Palsy Following Total Hip Arthroplasty : Prognostic Factors for Recovery 2013;55:5–9.
13. Schinsky MF, Macaulay W, Parks ML, Kiernan H, Nercessian OA. Nerve injury after primary total knee arthroplasty. J Arthroplasty 2001;16:1048–54. doi:10.1054/arth.2001.26591.
14. Kaushal SP, Galante JO, McKenna R, Bachmann F. Complications following total knee replacement. Clin Orthop Relat Res 1976:181–7.
15. Weale AE, Newman P, Ferguson IT, Bannister GC. Nerve injury after posterior and direct lateral approaches for hip replacement. A clinical and electrophysiological study. J Bone Joint Surg Br 1996;78:899–902.
16. Weber ER, Daube JR, Coventry MB. Peripheral neuropathies associated with total hip arthroplasty. J Bone Joint Surg Am 1976;58:66–9.
17. Schmalzried TP, Amstutz HC, Dorey FJ. Nerve palsy associated with total hip replacement. Risk factors and prognosis. J Bone Joint Surg Am 1991;73:1074–80.
18. Nercessian OA, Macaulay W, Stinchfield FE. Peripheral neuropathies following total hip arthroplasty. J Arthroplasty 1994;9:645–51.
19. Johanson NA, Pellicci PM, Tsairis P, Salvati EA. Nerve injury in total hip arthroplasty. Clin Orthop Relat Res 1983:214–22.
20. Borrelli J, Kantor J, Ungacta F, Ricci W. Intraneural sciatic nerve pressures relative to the position of the hip and knee: a human cadaveric study. J Orthop Trauma 2000;14:255–8.
21. Fleming RE, Michelsen CB, Stinchfield FE. Sciatic paralysis. A complication of bleeding following hip surgery. J Bone Joint Surg Am 1979;61:37–9.
22. Wang T-I, Chen H-Y, Tsai C-H, Hsu H-C, Lin T-L. Distances between bony landmarks and adjacent nerves: anatomical factors that may influence retractor placement in total hip replacement surgery. J Orthop Surg Res 2016;11:31.
23. Hurd JL, Potter HG, Dua V, Ranawat CS. Sciatic nerve palsy after primary total hip arthroplasty: a new perspective. J Arthroplasty 2006;21:796–802. doi:10.1016/j.arth.2005.08.008.
24. Pokorný D, Jahoda D, Veigl D, Pinskerová V, Sosna A. Topographic variations of the relationship of the sciatic nerve and the piriformis muscle and its relevance to palsy after total hip arthroplasty. Surg Radiol Anat 2006;28:88–91.
25 Solheim LF, Hagen R. Femoral and sciatic neuropathies after total hip arthroplasty. Acta Orthop Scand 1980;51:531–4.
26. Cohen DE, Van Duker B, Siegel S, Keon TP. Common peroneal nerve palsy associated with epidural analgesia. Anesth Analg 1993;76:429–31.
27. Xu L, Veeravagu A, Azad T, Harraher C, Ratliff J. Delayed Presentation of Sciatic Nerve Injury after Total Hip Arthroplasty: Neurosurgical Considerations, Diagnosis, and Management. J Neurol Surg Reports 2016;77:e134–8.
28. Pandey P, Pawar I. Postoperative Total Sciatic Nerve Palsy After Cemented Bipolar Hemi-arthroplasty : Sciatic Nerve Found Sutured With Capsule 2015;14:7–9.
29. Neves P. Compressive Iliac Aneurysm: A Rare Case of Sciatic Nerve Palsy after Total Hip Replacement. MOJ Orthop Rheumatol 2016;4:4–6.
30. Highet WB, Holmes W. Traction injuries to the lateral popliteal nerve and traction injuries to peripheral nerves after suture. Br J Surg 1943;30:212–33. .
32. Lundborg G, Rydevik B. Effects of stretching the tibial nerve of the rabbit. A preliminary study of the intraneural circulation and the barrier function of the perineurium. J Bone Joint Surg Br 1973;55:390–401.
33. Bryan RS, Peterson LF, Combs JJ. Polycentric knee arthroplasty. A preliminary report of postoperative complications in 450 knees. Clin Orthop Relat Res n.d.:148–52.
34. Insall JN, Ranawat CS, Aglietti P, Shine J. A comparison of four models of total knee-replacement prostheses. J Bone Joint Surg Am 1976;58:754–65.
35. Miyasaka KC, Ranawat CS, Mullaji A. 10- to 20-year followup of total knee arthroplasty for valgus deformities. Clin Orthop Relat Res 1997:29–37.
36. Webster DA, Murray DG. Complications of Variable Axis total knee arthroplasty. Clin Orthop Relat Res 1985:160–7.
37. Bruzzone M, Ranawat A, Castoldi F, Dettoni F, Rossi P, Rossi R. The Risk of Direct Peroneal Nerve Injury Using the Ranawat “Inside-Out” Lateral Release Technique in Valgus Total Knee Arthroplasty. J Arthroplasty 2010;25:161–5.
38. Knutson K, Leden I, Sturfelt G, Rosen I, Lidgren L. Nerve palsy after knee arthroplasty in patients with rheumatoid arthritis. Scand J Rheumatol 1983;12:201–5.
39. Weingarden SI, Louis DL, Waylonis GW. Electromyographic changes in postmeniscectomy patients. Role of the pneumatic tourniquet. JAMA 1979;241:1248–50.
40. Wakai A, Winter DC, Street JT, Redmond PH. Pneumatic tourniquets in extremity surgery. J Am Acad Orthop Surg n.d.;9:345–51.
41. Gomez D, Sidhu S, Jha K. Femoral And Saphenous Nerve Palsy Post-Total Knee Replacement 2005;3:1–4.
42. Dobner JJ, Nitz AJ. Postmeniscectomy tourniquet palsy and functional sequelae. Am J Sports Med 1982;10:211–4.
44. Rorabeck CH, Kennedy JC. Tourniquet-induced nerve ischemia complicating knee ligament surgery. Am J Sports Med 1980;8:98–102..
45. Ochoa J, Fowler TJ, Gilliatt RW. Anatomical changes in peripheral nerves compressed by a pneumatic tourniquet. J Anat 1972;113:433–55.
46. Bruner JM. Time, pressure, and temperature factors in the safe use of the tourniquet. Hand 1970;2:39–42.
47. Heppenstall RB, Balderston R, Goodwin C. Pathophysiologic effects distal to a tourniquet in the dog. J Trauma 1979;19:234–8.
48. Klenerman L. Tourniquet time — How long? Hand 1980;12:231–4.
49. Olivecrona C, Blomfeldt R, Ponzer S, Stanford BR, Nilsson BY. Tourniquet cuff pressure and nerve injury in knee arthroplasty in a bloodless field: A neurophysiological study. Acta Orthop 2013;84:159–64.
50. Pedowitz RA, Gershuni DH, Schmidt AH, Fridén J, Rydevik BL, Hargens AR. Muscle injury induced beneath and distal to a pneumatic tourniquet: a quantitative animal study of effects of tourniquet pressure and duration. J Hand Surg Am 1991;16:610–21.
51. Upton AR, McComas AJ. The double crush in nerve entrapment syndromes. Lancet (London, England) 1973;2:359–62.
52. Jacob AK, Mantilla CB, Sviggum HP, Schroeder DR, Pagnano MW, Hebl JR. Perioperative Nerve Injury after Total Knee Arthroplasty. Anesthesiology 2011;114:311–7.
53. Shetty T, Nguyen JT, Sasaki M, Wu A, Bogner E, Burge A, et al. Risk factors for acute nerve injury after total knee arthroplasty. Muscle Nerve 2018.
54. Su EP. HIP ARTHROPLASTY : AVOIDING AND MANAGING PROBLEMS Retraction : Post-operative neuropathy after total hip arthroplasty n.d.:46–9.
55. Fine M De, Romagnoli M, Zaffagnini S, Pignatti G. Sciatic Nerve Palsy following Total Hip Replacement : Are Patients Personal Characteristics More Important than Limb Lengthening ? A Systematic Review 2017;2017.
56. Sakai T, Sugano N, Fujii M, Nishii T, Ohzono K, Yoshikawa H. Sciatic nerve palsy after cementless total hip arthroplasty. Treatment by modular neck and calcar shortening: A case report. J Orthop Sci 2002;7:400–2.
57. Schmalzried TP, Noordin S, Amstutz HC. Update on nerve palsy associated with total hip replacement. Clin Orthop Relat Res 1997:188–206.
58. Macheras GA, Christofilopoulos P, Lepetsos P, Leonidou AO, Anastasopoulos PP, Galanakos SP. Nerve injuries in total hip arthroplasty with a mini invasive anterior approach. HIP Int 2016;26:338–43. doi:10.5301/hipint.5000352.
59. Pekkarinen J, Alho A, Puusa A, Paavilainen T. Recovery of sciatic nerve injuries in association with total hip arthroplasty in 27 patients. J Arthroplasty 1999;14:305–11.
60. SUNDERLAND S. Blood supply of the sciatic nerve and its popliteal divisions in man. Arch Neurol Psychiatry 1945;54:283–9.
61. Unwin A, Scott J. Nerve palsy after hip replacement: Medico-legal implications. Int Orthop 1999;23:133–7.
62. Simmons C, Izant TH, Rothman RH, Booth RE, Balderston RA. Femoral neuropathy following total hip arthroplasty. Anatomic study, case reports, and literature review. J Arthroplasty 1991;6 Suppl:S57-66.
63. Miozzari HH, Dora C, Clark JM, Nötzli HP. Late repair of abductor avulsion after the transgluteal approach for hip arthroplasty. J Arthroplasty 2010;25:450–457.e1.
64. Weber M, Berry DJ. Abductor avulsion after primary total hip arthroplasty. Results of repair. J Arthroplasty 1997;12:202–6.
65. Hendry J, Biant LC, Breusch SJ. Abductor mechanism tears in primary total hip arthroplasty. Arch Orthop Trauma Surg 2012;132:1619–23.
66. Grossman MG, Ducey SA, Nadler SS, Levy AS. Meralgia paresthetica: diagnosis and treatment. J Am Acad Orthop Surg n.d.;9:336–44.
67. Coert JH, Dellon AL. Documenting Neuropathy of the Lateral Femoral Cutaneous Nerve Using the Pressure-Specified Sensory Testing Device. Ann Plast Surg 2003;50:373–7. doi:10.1097/01.SAP.0000041483.93122.58.
68. Barton C, Kim PR. Complications of the Direct Anterior Approach for Total Hip Arthroplasty. Orthop Clin North Am 2009;40:371–5. doi:10.1016/j.ocl.2009.04.004.
69. Goulding K, Beaule PE, Kim PR, Ma AF. Incidence of Lateral Femoral Cutaneous Nerve Neuropraxia After Anterior Approach Hip Arthroplasty 2010:2397–404. doi:10.1007/s11999-010-1406-5.
70. Bender B, Nogler M, Hozack WJ. Direct anterior approach for total hip arthroplasty. Orthop Clin North Am 2009;40:321–8. .
71. GIBSON A. Posterior exposure of the hip joint. J Bone Joint Surg Br 1950;32–B:183–6.
72. Ling ZX, Kumar VP. The course of the inferior gluteal nerve in the posterior approach to the hip n.d.:1580–3. doi:10.1302/0301-620X.88B12.18182.
73. Henningsen MH, Jæger P, Hilsted KL, Dahl JB. Nerve injury and adductor-canal-blockade. Acta Anaesthesiol Scand 2013;57:112–7.
74. Siliski JM, Scott RD. Obturator-nerve palsy resulting from intrapelvic extrusion of cement during total hip replacement. Report of four cases. J Bone Joint Surg Am 1985;67:1225–8.
75. Wolf M, Bäumer P, Pedro M, Dombert T, Staub F, Heiland S, et al. Sciatic Nerve Injury Related to Hip Replacement Surgery: Imaging Detection by MR Neurography Despite Susceptibility Artifacts. PLoS One 2014;9:e89154. .
76. Chhabra A, Andreisek G, Soldatos T, Wang KC, Flammang AJ, Belzberg AJ, et al. MR neurography: Past, present, and future. Am J Roentgenol 2011;197:583–91. doi:10.2214/AJR.10.6012.
77. Engelbrecht E, Siegel A, ROTTGER J, Buchholz HW. Statistics of total knee replacement: partial and total knee replacement, design St. Georg: a review of a 4-year observation. Clin Orthop Relat Res 1976:54–64.
78. Clawson DK, Seddon HJ. THE RESULTS OF REPAIR OF THE SCIATIC NERVE. J Bone Joint Surg Br 1960;42–B:205–12.
79. Ulrich SD, Bhave A, Marker DR, Seyler TM, Mont MA. Focused rehabilitation treatment of poorly functioning total knee arthroplasties. Clin Orthop Relat Res 2007;464:138–45.
80. Krackow KA, Maar DC, Mont MA, Carroll C. Surgical decompression for peroneal nerve palsy after total knee arthroplasty. Clin Orthop Relat Res 1993:223–8.
81. MONT MA, DELLON AL, CHEN F, HUNGERFORD MW, KRACKOW KA, HUNGERFORD DS. The Operative Treatment of Peroneal Nerve Palsy*. J Bone Jt Surg 1996;78:863–9.
82. Wilson TJ, Kleiber GM, Nunley RM, Mackinnon SE, Spinner RJ. Distal peroneal nerve decompression after sciatic nerve injury secondary to total hip arthroplasty. J Neurosurg 2018:1–5.
83. Regev GJ, Drexler M, Sever R, Dwyer T, Khashan M, Lidar Z, et al. Neurolysis for the treatment of sciatic nerve palsy associated with total hip arthroplasty. Bone Joint J 2015;97–B:1345–9.
84. Lavigne MJ, Sanchez AA, Coutts RD. Recurrent dislocation after total hip arthroplasty: treatment with an Achilles tendon allograft. J Arthroplasty 2001;16:13–8.
85. DeHart MM, Riley LH. Nerve injuries in total hip arthroplasty. J Am Acad Orthop Surg n.d.;7:101–11.
86. Omar NB, Ditty BJ, Rozzelle CJ. Medicolegal Aspects of Peripheral Nerve Injury. Nerves Nerve Inj., Elsevier; 2015, p. 707–8.
87. Bhutta MA, Arshad MS, Hassan S, Henderson JJ. Trends in joint arthroplasty litigation over five years: The British experience. Ann R Coll Surg Engl 2011;93:460–4.
88. padhyay A, York S, Macaulay W, McGrory B, Robbennolt J, Bal BS. Medical Malpractice in Hip and Knee Arthroplasty. J Arthroplasty 2007;22.

How to Cite this article: Shah K, Desai M. Prevalence of Nerve Injuries in Lower Limb following Total Joint Replacement Surgery, and Management. Journal of Clinical Orthopaedics July-Dec 2018; 3(2):36-43.

(Abstract    Full Text HTML)      (Download PDF)

Simultaneous Bilateral Total Knee Replacement – Current Evidence Based Management Strategy

Vol 3 | Issue 2 |  July-Dec 2018 | Page 22-29 | Abhishek Patil, Nandan Rao.

Authors: Abhishek Patil [1], Nandan Rao [2].

[1] Department of Joint Replacement and Orthopaedics, Sahyadri Superspeciality Hospital Hadapsar, Pune, Maharashtra, India
[2] Department of Orthopaedics Reliance Hospital, Navi Mumbai, Maharashtra, India.

Address of Correspondence
Dr. Abhishek Patil, Sahyadri Superspeciality Hospital, Survey number 163, Bhosale nagar, Pune-Solapur road, Hadapsar, Pune. 411028


With an ever-increasing geriatric population and associated knee arthritis; the number of patients requiring total knee arthroplasty continues to rise. In India 94% of patients with Kellegren-Lawrence grade 3 or 4 arthritis have bilateral arthritis. As such bilateral knee arthroplasty offers the convenience of single surgery, concomitant recovery and rehab of both knees and significant cost savings. However traditionally simultaneous bilateral knee replacement has been associated with higher mortality- both in hospital and after discharge extending up to 1 year and higher morbidity due to cardio-pulmonary complications, deep vein thrombosis, pulmonary embolism and higher rates of readmissions. With modern day surgical refinements and improved anesthetic practices; recent studies have reported results and complications at par with unilateral and staged bilateral total knee arthroplasty. However controversies do remain over the applicability of doing simultaneous bilateral knee arthroplasty. Ethical considerations and rarity of complications have made it difficult to conduct adequately powered randomized trials to justify or refute the practice of simultaneous bilateral knee arthroplasty. This review tries to amalgamate the views of recent literature to give the present status and best practices in simultaneous bilateral total knee arthroplasty.
Keywords: Total knee arthroplasty, bilateral total knee arthroplasty, bilateral knee replacement, knee arthritis, knee arthroplasty, knee replacement.


1. Kurtz S, Ong K, Lau E, et al. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg[Am] 2007;89(4):780-5.
2. Pal CP, Singh P, Chaturvedi S, Pruthi KK, Vij A. Epidemiology of knee osteoarthritis in India and related factors. Indian J Orthop 2016;50:518-22
3. Shadab M, Zulkifle M, Ansari A.H, Itrat M. Prevalence of knee osteoarthritis in patients visiting NIUM hospital Bangalore. International Journal of Herbal Medicine 2014; 2 (2): 61-64
4. Ritter MA, Meding JB. Bilateral simultaneous total knee arthroplasty. J Arthroplasty 1987;2(3):185-9
5. Hu J, Liu Y, Lv Z. Mortality and morbidity associated with simultaneous bilateral or staged bilateral total knee arthroplasty: a meta-analysis. Arch Orthop Trauma Surg 2011;131:1291-8
6. Meehan JP, Danielsen B, Tancredi DJ, et al. A population-based comparison of the incidence of adverse outcomes after simultaneous-bilateral and staged-bilateral total knee arthroplasty. J Bone Joint Surg Am 2011;93:2203-13
7. Kim YH, Choi YW, Kim JS (2009) Simultaneous bilateral sequential total knee replacement is as safe as unilateral total knee replacement. J Bone Joint Surg Br;91:64-68
8. Lane GJ, Hozack WJ, Shah S, et al. Simultaneous bilateral versus unilateral total kneearthroplasty. Outcomes analysis. ClinOrthopRelat Res 1997;345:106-12.
9. Oakes DA, Hanssen AD. Bilateral total knee replacement using the same anesthetic is not justified by assessment of the risks. ClinOrthopRelat Res 2004;428:87-91.
10. Parvizi J, Sullivan TA, Trousdale RT, et al. Thirty-day mortality after total knee arthroplastyJ Bone Joint Surg [Am] 2001;83-A:1157-61
11. Stavros G. Memtsoudis et al. Consensus Statement from the Consensus Conference on Bilateral Total Knee Arthroplasty Group.ClinOrthopRelat Res (2013) 471:2649-57
12. 5. Vince KG. Bilateral total knee arthroplasty under one anesthesia: a safe protocol.MayoClinProc 1997;72:883-5.
13. Adili A, Bhandari M, Petruccelli D, DeBeer J. Sequential bilateral total kneearthroplasty under 1 anesthetic in patients > or =75 years old: complications and functional outcomes. J Arthroplasty 2001;16:271-8.
14. Bullock DP, Sporer SM, Shirreffs TG Jr. Comparison of simultaneous bilateral with unilateral total knee arthroplasty in terms of perioperative complications. J Bone Joint Surg [Am] 2003;85-A:1981-6.
15. Gill GS, Mills D, Joshi AB. Mortality following primary total knee arthroplasty. J Bone Joint Surg [Am] 2003;85-A:432-5.
16. Kim YH, Choi YW, Kim JS. J Bone Joint Surg Br. 2009 Jan;91(1):64-8
17. Memtsoudis SG, Ma Y et al. Bilateral total knee arthroplasty: risk factors for major morbidity and mortality. AnesthAnalg. 2011 Oct;113(4):784-90.
18. Studner o, Chiu Y L et al. Comparative perioperative outcomes associated with neuraxial versus general anesthesia for simultaneous bilateral total knee arthroplasty.RegAnesth Pain Med. 2012 Nov-Dec;37(6):638-44.
19. Rodgers A, Walker N, Schug S, et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ. 2000;321:1493.
20. Wijeysundera DN, Beattie WS et al. Epidural anaesthesia and survival after intermediate-to-high risk non-cardiac surgery: a population-based cohort study. Lancet.2008;372:562-69.\
21. Liu PL, Li DQ et al. Effects of Unilateral Tourniquet Used in Patients Undergoing Simultaneous Bilateral Total Knee Arthroplasty Orthop Surg. 2017 May;9(2):180-5.
22. Zhang W, Li N et al. The effects of a tourniquet used in total knee arthroplasty: a meta-analysis.JOrthopSurg Res. 2014 Mar 6;9(1):13.
23. Ozkunt O, Sariyilmaz K. The effect of tourniquet usage on cement penetration in total knee arthroplasty: A prospective randomized study of 3 methods.Medicine (Baltimore). 2018 Jan;97(4):e9668.
24. Thorey F, Stukenborg-Colsman C, Windhagen H, Wirth CJ. The effect of tourniquet release timing on perioperative blood loss in simultaneous bilateral cemented total knee arthroplasty: a prospective randomized study. Technol Health Care. 2008;16:85-92.
25. Hutchinson JR, Parish EN, Cross MJ. A comparison of bilateral uncemented total knee arthroplasty: simultaneous or staged? J Bone Joint Surg Br 2006;88(1):40-3.
26. Bullock DP, Sporer SM, ShirreffsJr TG. Comparison of simultaneous bilateral with unilateral total knee arthroplasty in terms of perioperative complications. J Bone Joint Surg Am 2003;85-A(10):1981-6.
27. Chen X, Cao X et al. Effectiveness and Safety of Fixed-Dose Tranexamic Acid in Simultaneous Bilateral Total Knee Arthroplasty: A Randomized Double-Blind Controlled Trial.J Arthroplasty. 2016 Nov;31(11):2471-5 .
28. MacGillivray RG, Tarabichi SB, Hawari MF, et al. Tranexamic acid to reduce blood loss after bilateral total knee arthroplasty: a prospective, randomized d double blind study. J Arthroplasty 2011;26(1):24-8
29. Kim TK, Chang CB, Kang YG, et al. Clinical value of tranexamic acid in unilateral and simultaneous bilateral TKAs under a contemporary blood-saving protocol: a randomized controlled trial. Knee Surg Sports TraumatolArthrosc 2014;22(8):1870-8.
30. Seo JG, Moon YW, Park SH, et al. The comparative efficacies of intra- articular and IV tranexamic acid for reducing blood loss during total knee arthroplasty. Knee Surg Sports TraumatolArthrosc 2013;21:1869-74
31. Aggarwal AK, Singh N, Sudesh P. Topical vs Intravenous Tranexamic Acid in Reducing Blood Loss After Bilateral Total Knee Arthroplasty: A Prospective Study.J Arthroplasty. 2016 Jul;31(7):1442-8.
32. Wong E, Nguyen CL et al. Simultaneous, same-anaesthetic bilateral total knee arthroplasty has low mortality and complication rates.KneeSurg Sports TraumatolArthrosc. 2018 Nov;26(11):3395-3402
33. Peskun C, Mayne I et al Backstein D. Cardiovascular disease predicts complications following bilateral total knee arthroplasty under a single anesthetic.Knee. 2012;19:580-4.
34. Reidy CM, Beach Mlet al hemodynamic instability after simultaneous bilateral total knee arthroplasty. J Patient Saf. 2010;6:233-7.
35. Chaumeron A, AudyDet al. Periarticular injection in knee arthroplasty improves quadriceps function. ClinOrthopRelat Res. 2013 Jul;471(7):2284-95.
36. TsukadaS,Wakui M, Hoshino A. Postoperative epidural analgesia compared with intraoperativeperiarticular injection for pain control following total knee arthroplasty under spinal anesthesia: a randomized controlled trial. J Bone Joint Surg Am. 2014 Sep 3;96(17):1433-8.
37. Tsukada S, Wakui M et al. Pain control after simultaneous bilateral total knee arthroplasty: a randomized controlled trial comparing periarticular injection and epidural analgesia.J Bone Joint Surg Am. 2015 Mar 4;97(5):367-73.
38. Lombardi AV Jr, Berend KR, Mallory TH, Dodds KL, Adams JB. Soft tissue and intra-articular injection of bupivacaine, epinephrine, and morphine has a beneficial effect after total knee arthroplasty. ClinOrthopRelat Res. 2004 Nov;(428):125-30.
39. Mont MA, Jacobs JJ. AAOS clinical practice guideline: preventing venous thromboembolic disease in patients undergoing elective hip and knee arthroplasty. J Am AcadOrthop Surg. 2011 Dec;19(12):777-8
40. Barrett J, Baron JA, Losina E, Wright J, Mahomed NN, Katz JN (2006) Bilateral total knee replacement: staging and pulmonary embolism. J Bone Joint Surg Am 88:2146-51
41. Hu J, Liu Y et al. Mortality and morbidity associated with simultaneous bilateral or staged bilateral total knee arthroplasty: a meta-analysis.ArchOrthop Trauma Surg. 2011 Sep;131(9):1291-8.
42. Bottner F, Sculco TP. Nonpharmacologic thromboembolic prophylaxis in total knee arthroplasty. ClinOrthopRelat Res 2001 Nov;(392):249-56.
43. Colwell Jr CW, Berkowitz SD, Lieberman JR, et al. Oral direct thrombin inhibitor ximelagatran compared with warfarin for the prevention of venous thromboembolism after total knee arthroplasty. J Bone Joint Surg Am 2005 Oct;87(10):2169-77.
44. Nam D, Nunley RM et al. Mobile compression devices and aspirin for VTE prophylaxis following simultaneous bilateral total knee arthroplasty.J Arthroplasty. 2015 Mar;30(3):447-50 .
45. Azboy I, Barrack R et al. Aspirin and the prevention of venous thromboembolism following total joint arthroplasty: commonly asked questions.Bone Joint J. 2017 Nov;99-B(11):1420-30.
46. Parvizi J, Huang R, Raphael IJ, et al. Timing of Symptomatic Pulmonary Embolism with Warfarin Following Arthroplasty. J Arthroplasty 2015;30:1050-53.
47. Brighton TA, Eikelboom JW, Mann K, et al. Low-dose aspirin for preventing recurrent venous thromboembolism. N Engl J Med 2012;367:1979-87.
48. Sheth DS, CafriG et al . Bilateral Simultaneous vs Staged Total Knee Arthroplasty: A Comparison of Complications and Mortality. J Arthroplasty 2016 Sep;31(9 Suppl):212-6.
49. Fu D, Li G et al. Comparison of clinical outcome between simultaneous-bilateral and staged-bilateral total knee arthroplasty: a systematic review of retrospective studies.J Arthroplasty. 2013 Aug;28(7):1141-7.
50. Seol JH, Seon JK, Song EK. Comparison of postoperative complications and clinical outcomes between simultaneous and staged bilateral total knee arthroplasty.JOrthop Sci. 2016 Nov;21(6):766-69
51. Bagsby D, Pierson JL. Functional outcomes of simultaneous bilateral versus unilateral total knee arthroplasty.Orthopedics. 2015 Jan;38(1):e43-7
52. Restrepo C1, Parvizi J et al. Safety of simultaneous bilateral total knee arthroplasty. A meta-analysis.J Bone Joint Surg Am. 2007 Jun;89(6):1220-6.
53. Chua HS, Whitehouse SL et al. Mortality and Implant Survival With Simultaneous and Staged Bilateral Total Knee Arthroplasty Experience From the Australian Orthopaedic Association National Joint Replacement Registry.J Arthroplasty. 2018 Oct;33(10):3167-73.
54. Hussain N, Chien T . Simultaneous versus staged bilateral total knee arthroplasty: a meta-analysis evaluating mortality, peri-operative complications and infection rates.HSS J. 2013 Feb;9(1):50-9.
55. Poultsides LA, Memtsoudis SG et al. Infection following simultaneous bilateral total knee arthroplasty.J Arthroplasty. 2013 Sep;28(8 Suppl):92-5.
56. Pulido L, Ghanem E, Joshi A, et al. Periprosthetic joint infection: the incidence, timing, and predisposing factors. ClinOrthopRelat Res 2008;466:1710.
57. MuralidharanVenkatesan, DevendraMahadevan, Robert U. Ashford. Computer-Assisted Navigation in Knee Arthroplasty: A Critical Appraisal. J Knee Surg 2013;26:357-62.
58. Rajesh Malhotra, AmitSingla et al. A Prospective Randomized Study to Compare Systemic Emboli Using the Computer-Assisted and Conventional Techniques of Total Knee Arthroplasty. J Bone Joint Surg Am. 2015;97:889-94.
59. Mary O Connor, Mark Brodersen et al. Fat embolism in total knee arthroplasty, A prospective control study of navigation VS standard surgical techniques. JOA 2010;25:1034-40.
60. Su Chan Lee et al. Cerebral fat embolism after simultaneous bilateral total knee arthroplasty a case series. JOA 2012;27:409-14.
61. Y. Kalairajah, A. J. Cossey et al. Are systemic emboli reduced in computerassisted knee surgery? A Prospective Randomised clinical trial. J Bone Joint Surg [Br] 2006;88-B:198-202.
62. Lee WC, Kwan YH, Yeo SJ.Severe Bilateral Fixed Flexion Deformity-Simultaneous or Staged Total Knee Arthroplasty?J Arthroplasty. 2016 Jan;31(1):128-31.
63. Jankiewicz JJ, Sculco TP, Ranawat CS, Behr C, Tarrentino S. One-stage versus 2-stage bilateral total knee arthroplasty. ClinOrthopRelat Res. 1994; (309):94-101.
64. Reuben JD, Meyers SJ, et al. Cost comparison between bilateral simultaneous, staged, and unilateral total joint arthroplasty. J Arthroplasty. 1998; 13(2):172-9.
65. Aaron Chih-Chang Lin, En Chao, et al. Costs of staged versus simultaneous bilateral total knee arthroplasty: a population-based study of the Taiwanese National Health Insurance Database.JOrthopSurg Res. 2014; 9: 59.
66. Odum SM, Troyer JL, Kelly MP, Dedini RD, Bozic KJ. A cost-utility analysis comparing the cost-effectiveness of simultaneous and staged bilateral total knee arthroplasty. The Journal of bone and joint surgery American 2013;95(16):1441-9.
67. Sobh AH, Siljander MP et al.Cost Analysis, Complications, and Discharge Disposition Associated With Simultaneous vs Staged Bilateral Total Knee Arthroplasty.J Arthroplasty. 2018 Feb;33(2):320-323.
68. Buhagiar MA, Naylor JM, et al. Effect of Inpatient Rehabilitation vs a Monitored Home-Based Program on Mobility in Patients With Total Knee Arthroplasty: The HIHO Randomized Clinical Trial. The Journal of the American Medical Association. 2017;317(10):1037-46.
69. Reuben JD, Meyers SJ. Et al. Cost comparison between bilateral simultaneous, staged, and unilateral total joint arthroplasty.J Arthroplasty. 1998 Feb;13(2):172-9.
70. Seo JG, Lee BH et al. Disparate postoperative results in the first and second knees on simultaneous bilateral total knee arthroplasty.J Arthroplasty. 2014 Dec;29(12):2331-6.
71. Meehan JP, Blumenfeld TJ. Risks and Benefits of Simultaneous Bilateral Total Knee Arthroplasty: A Critical Analysis Review.JBJS Rev. 2015 Feb 17;3(2).
72. Husted H, Troelsen A et al.Fast-track surgery for bilateral total knee replacement.J Bone Joint Surg Br. 2011 Mar;93(3):351-6.
73. Huotari K, LyytikΣinen O, Seitsalo S. Hospital Infection Surveillance Team. Patient outcomes after simultaneous bilateral total hip and knee joint replacements.JHosp Infect 2007;65:219-25.
74. Schwenk W, Mler JM. What is “Fast-track”-surgery?.Dtsch Med Wochenschr. 2005 Mar 11;130(10):536-40
75.Kehlet H, Wilmore D W. Multimodal strategies to improve surgical outcome. Am J Surg 2002; 183: 630-41
76. Husted H, Holm G, Jacobsen S .Predictors of length of stay and patient satisfaction after hip and knee replacement surgery: fast-track experience in 712 patients.ActaOrthop. 2008 Apr;79(2):168-73.
77. Dorr LD, Udomkiat P et al. Intraoperative monitoring for safety of bilateral total knee replacement.ClinOrthopRelat Res. 2002 Mar;(396):142-51.
78. Bottner F, Pavone V et al. Blood management after bilateral total knee arthroplasty. ClinOrthopRelat Res. 2003;410:254-61.

How to Cite this article: Patil A, Rao N. Simultaneous Bilateral Total Knee Replacement – Current Evidence Based Management Strategy. Journal of Clinical Orthopaedics July-Dec 2018; 3(2):22-29.

(Abstract    Full Text HTML)      (Download PDF)