A significant number of patients with degenerative joint disease have severe symptoms in both knees and need bilateral total knee replacement. The surgical options available for these patients include a staged procedure with a time interval (generally several months) between two surgeries and a simultaneous replacement of both knees in a single surgery. “The advantages of simultaneous bilateral total knee replacement are well known,” says Dr. Fauser. “The patient undergoes a single surgery and anesthesia, a single hospital stay and a single rehabilitation period. Studies have also shown that simultaneous replacement is associated with a lower risk of post-operative infection and mechanical malfunction compared to two separate procedures.”
These advantages make simultaneous replacement an attractive option for patients. In one study, 95% of those who had undergone simultaneous replacement would elect to do so again. However, simultaneous replacement may not be appropriate for all patients. In most studies, the rates of cardiac, pulmonary, and neurological complications have been reported to be greater for simultaneous bilateral replacement, particularly in patients over 80 years old. “Advances in surgical technique, anesthesia and recovery management have made total knee replacement a safe and effective option for more elderly patients than ever before,” says Dr. Fauser. “But those patients who are older are also likely to be sicker and at higher risk for cardiovascular and respiratory complications. Clearly, every patient, along with his or her doctor, must carefully weigh all the factors and risks in deciding between simultaneous and staged knee replacement.”
Normal knee function is required to perform most everyday activities. The knee, the largest joint in the body, acts as a hinge to provide motion where the thigh meets the lower leg. The thigh bone (femur) meets the large bone of the lower leg (tibia) at the knee joint, protected in the front by the kneecap (patella). The joint surfaces where these three bones touch are covered with cartilage, a smooth substance that cushions the bones and enables them to move easily. All remaining surfaces of the knee are covered by a thin, smooth tissue liner called the synovial membrane that releases synovial fluid that lubricates the knee, reducing friction to nearly zero in a healthy knee. Normally, all of these components work in harmony. But disease or injury can disrupt this harmony, resulting in pain, muscle weakness, and reduced function.
The most common cause of chronic knee pain and disability is arthritis, usually osteoarthritis, rheumatoid arthritis or traumatic arthritis:
• Osteoarthritis usually occurs as we age and the cartilage that cushions the bones of the knee softens and wears away. The bones then rub against one another, causing knee pain and stiffness. A study published by the Centers for Disease Control (CDC) reports that nearly half (46%) of American adults and 2/3 of obese adults will develop painful knee osteoarthritis at some point.
• Rheumatoid arthritis is a disease in which the synovial membrane becomes chronically inflamed, eventually causing cartilage loss, pain, and stiffness.
• Traumatic arthritis can follow a serious knee injury such as a fracture or severe tears of the ligaments that may damage the cartilage over time, causing knee pain and limiting knee function.
When the surface of the joint is worn away, walking and daily activities become very difficult. Standardized treatment such as weight loss, anti-inflammatory medication, braces, orthotics, steroid injections, and physical therapy are generally tried and may be effective. In many cases, however, non-surgical treatments fail to correct functional limitations and relieve progressive pain, leading people to consider knee replacement.
“When we perform a total knee replacement, we remove damaged cartilage and bone from the surface of the knee joint and replace it with a man-made surface of metal and plastic,” says Dr. Fauser. “Resurfacing the damaged and worn surfaces of the knee can relieve pain, correct leg deformity and help the patient resume normal activities.”
“We encourage patients to talk with their doctors to weigh the factors and risks to decide whether to have staged knee replacement or to fix two knees at once,” Dr. Fauser concludes. “The good news is that the technology is providing increasing relief to more and more patients each year and there are more options available for individual circumstances.”
Somers Orthopaedic Surgery & Sports Medicine Group, founded in 1988, is one of the most comprehensive and specialized practices in the region. Highly trained physicians specialize in diagnosing and treating all orthopaedic, rheumatological, and pain management problems in adults and children. All surgeons are board certified and experienced, having completed rigorous training at the finest medical institutions in the country. The staff includes fifteen physicians, five physicians' assistants, three physical therapists and a supporting staff of over 100. The group's physicians perform all types of arthroscopic surgery, ACL reconstruction, minimally invasive joint replacement, computer navigation, revision joint replacement, sports care, spine surgery, fracture care, hand, ankle, and foot surgery. State-of-the-art facilities include digital radiology, MRI and ultrasound. www.somersortho.com
Douglas J. Fauser, M.D., F.A.A.O.S., F.A.C.S., a founding partner of Somers Orthopaedic, received board certification in 1990. He is on staff at Northern Westchester Hospital Center in Mount Kisco, the Hospital for Joint Diseases in New York City, and Putnam Hospital Center in Carmel, where he is co-director at the Orthopaedic Institute. He is also a clinical assistant professor of orthopaedic surgery at the New York University School of Medicine/Hospital for Joint Disease Orthopaedic Institute. Dr. Fauser is a fellow of the American Academy of Orthopaedic Surgeons and a member of the American Board of Orthopaedic Professional Surgeons, as well as a member of the American College of Surgeons. He received his medical degree from the New York University School of Medicine and completed a residency in general surgery at Wilmington Medical Center, Delaware and a residency in orthopaedic surgery at the Hospital for Joint Diseases.
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