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Resume Introduction La morbi-mortalite precoce du remplacement prothetique bilateral de genou (PTG Bi) en une session operatoire est un sujet d’interet dans la litterature medicale. L’evolution clinique a long terme de cette strategie est quant a elle bien moins etudiee. L’objectif de cette etude etait de rapporter les complications tardives (> 90 jours), les resultats cliniques, KOOS et new IKS, ainsi que la survie prothetique des PTG Bi en une session operatoire. L’hypothese etait qu’une strategie de PTG Bi en une session operatoire entrainait peu de complications tardives et une survie prothetique compatible avec les criteres du National Institute of health and Clinical Excellence (NICE). Methode Cette etude retrospective monocentrique a analyse sur une periode de 8 ans, entre 2009 et 2016, une cohorte de patients ASA 1 et 2 operes par PTG bilaterales en une session operatoire. La population se composait de 116 patients, en majorite des femmes (65,5 % femmes vs 34,5 % d’hommes) avec un âge moyen a l’inclusion de 69 ans (32–85 ans) ; 22,4 % des patients etaient ASA 1 et 77,6 % ASA 2. Les complications tardives prothetiques, mecaniques ou infectieuses survenues apres les 90 premiers jours postoperatoires, les resultats cliniques (scores KOOS, new IKS) et radiographiques, ainsi que la courbe de survie, ont ete enregistres lors des consultations de controle systematiques a 3 mois, 6 mois et 1 an postoperatoire et lors du suivi a long terme ou lors d’un evenement intercurrent. Resultats Aucun patient n’etait perdu de vue. Quinze complications etaient recensees (6,5 %) : 4 infections, 4 problemes rotuliens (3 « clunck syndrome » et un syndrome douloureux rotulien), 4 raideurs, 2 douleurs inexpliquees et une fracture periprothetique femorale. Huit patients ont ete readmis (6,9 %) ; il y a eu 7 re-operations (3 %) et 2 revisions prothetiques (0,9 %). Les scores fonctionnels (KOOS et new IKS) etaient ameliores de maniere significative et 87 % des patients se disaient satisfaits ou tres satisfaits par cette intervention. A 5 ans de recul moyen, l’estimation de la survie prothetique par la methode de Kaplan-Meier etait de 98,4 % (IC 95 % = 0,933–0,996) Conclusion La realisation de PTG Bi en une session operatoire est une strategie fiable car elle engendre un faible taux de complications tardives, d’excellents resultats a moyen terme ainsi qu’une courbe de survie compatible avec les criteres du NICE, permettant ainsi de verifier l’hypothese de cette etude. Niveau de preuve IV, etude retrospective.

Bilateral total knee arthroplasty (TKA) in a single session is rarely done in France, mainly due to the increased risk of perioperative and late complications. The primary objective of this study was to compare the complication rates of same-day bilateral TKA (TKA bilat) with that of unilateral TKA (TKA unilat). The hypothesis was bilateral TKA increases the rate of early and late complications in a group of selected patients (ASA 1 or 2, less than 80 years of age).Retrospective comparative study of 91 bilat TKA and 182 unilat TKA cases operated on between 2009 and 2016 (1 bilat TKA paired with 2 controls). The patients were matched based on age, sex, indication and ASA score. The minimum follow-up was 2 years. Mortality along with early and late complications were documented. The secondary endpoints were implant survival, functional outcomes, and patient satisfaction.The early mortality rate was zero in both groups. The early complication rate was lower in the bilat TKA group (9%) than in the unilat TKA group (22%) (p0.001). The late complications did not differ between groups. Implant survival at 5 years was 99% (95% CI=[95.6-99.7]) in the bilat TKA group and 97% (95% CI=[92.8-98.8]) in the unilat TKA group. The autologous blood transfusion rate was 33% in the bilat TKA group and 2.2% in the unilat TKA group (p0.001). There was no difference between groups in the satisfaction rate or the KOOS and New IKS scores. A larger share of patients in the unilat TKA group (54%) said they had forgotten about their knee than in the bilat TKA group (43%) (p=0.036).There were few early complications in the bilat TKA group. There was no significant difference in the number of late complications, survival, functional scores, or patient satisfaction between the two groups. The transfusion rate was higher in the bilat TKA group, while the forgotten knee rate was higher in the unilat TKA group.Our hypothesis was not confirmed: in the context of this study, in patients who are ASA 1 or 2, and less than 80 years old, same-day bilateral TKA does not increase the complication rate relative to unilateral TKA.III, comparative study of continuous paired cases.

Resume Introduction Le remplacement prothetique de genou bilateral en une session operatoire offre les avantages d’un seul sejour hospitalier, d’une seule anesthesie, d’une reeducation raccourcie et d’une diminution du cout de prise en charge par patient. Cependant, des controverses existent, notamment du fait du risque perioperatoire. L’hypothese de cette etude etait que cette strategie n’engendre pas de mortalite perioperatoire precoce, ainsi qu’un taux de readmission et une morbidite precoces faibles dans une population de patients selectionnes par le score ASA. Methode Cette etude retrospective monocentrique a analyse, sur une periode de 8 ans entre 2009 et 2016, une cohorte de patients ASA 1 et 2 operes par PTG bilaterales en une session operatoire. La population etudiee se composait de cent seize patients, en majorite des femmes avec un âge moyen a l’inclusion de 69 ans ; 22,4 % des patients etaient ASA 1 et 77,6 % ASA 2. Les deces, les complications precoces, dans les 90 premiers jours postoperatoires, le taux de readmission precoce et la strategie d’epargne sanguine ont ete analyses, a partir des donnees cliniques et paracliniques relevees lors de l’hospitalisation, lors du sejour systematique en centre de convalescence, et lors des consultations de controle systematiques a 6 semaines et 3 mois postoperatoire. L’analyse a ete completee a l’aide du logiciel intra-hospitalier Clinicom, qui permet une tracabilite de tous les evenements et de tous les episodes pour chaque patient. Resultats Le taux de deces precoce etait nul. Cinq complications majeures (4,3 %) et treize complications mineures (11 %) ont ete observees. Le taux de readmission precoce etait de 5,2 %. La transfusion homologue postoperatoire concernait 36 % des patients et a ete diminuee par l’acide tranexamique a 24,3 % versus 44 % pour les patients sans acide tranexamique, (p = 0,06). Conclusion La mortalite perioperatoire, dans cette population selectionnee est nulle et la morbidite precoce acceptable. Le taux de readmission precoce est faible. Proposer une PTG bilaterale en une session operatoire a un patient repondant aux criteres definis dans cette etude est donc une strategie recevable. Niveau de preuve IV, etude retrospective.

Introduction The early morbidity and mortality of one-session bilateral total knee arthroplasty (1-session BTKA) has been reported in the medical literature. However, there is less information about the long-term clinical impact of this strategy. The aim of this study was to report on the late complications (> 90 days), clinical outcomes (KOOS and new KSS) along with the survivorship of 1-session BTKA. We hypothesised that 1-session BTKA will cause few late complications and that the implant survival will meet the criteria of the National Institute for Health and Clinical Excellence (NICE). Methods This single-centre retrospective study analysed a cohort of ASA-1 and ASA-2 patients who underwent 1-session BTKR over an 8-year period (2009 to 2016). The cohort consisted of 116 patients (66% women, 34% men) with mean age at inclusion of 69 years (32–85 years); 22% of patients were ASA-1 and 78% were ASA-2. The implant-related, infection-related or mechanical complications that occurred more than 90 days after the operation, the clinical outcomes (KOOS and New KSS) and radiological outcomes, along with the survivorship were determined during the scheduled follow-up visits at 3 months, 6 months and 1 year postoperative and during the long-term follow-up or during an intercurrent event. Results No patients were lost to follow-up. Fifteen complications occurred (6.5%): four infections, four patellar problems (three cases of clunk syndrome and one of patellofemoral pain), four cases of stiffness, two of unexplained pain and one femoral periprosthetic fracture. Eight patients were readmitted to the hospital (7%); seven were reoperated (3%) and two implants were revised (1%). The functional outcomes (KOOS and New KSS) were significantly improved and 87% of patients were satisfied or very satisfied with this procedure. At a mean follow-up of 5 years, the survivorship estimated using the Kaplan–Meier method was 98.4% (95% CI: 0.933–0.996). Conclusion Performing 1-session BTKA is a reliable strategy as it produces a low rate of late complications, excellent medium-term functional outcomes and survivorship that meets NICE criteria, thus confirming our hypothesis. Level of evidence IV, retrospective case series.

Introduction Single-stage bilateral total knee replacement (TKR) has the advantages of requiring only one hospital stay and one anesthesia session, having a shorter rehabilitation period, and reducing the cost of patient care. However, this strategy is controversial because of the perioperative risk. We hypothesized that this strategy did not cause early perioperative mortality and that the early morbidity and readmission rates would be low when patients are selected based on their ASA score. Methods This single-center retrospective study analyzed a cohort of ASA-1 and ASA-2 patients who underwent single-stage bilateral TKR over an 8-year period (2009 to 2016). The study cohort consisted of 116 patients, mainly women with mean age of 69 years at inclusion; 22.4% of patients were ASA-1 and 77.6% were ASA-2. Death and early complications during the first 90 days postoperative, the early readmission rate and the blood-sparing strategy were analyzed using the clinical and paraclinical data collected during the hospital stay, during the convalescent care center stay, and during the follow-up visits at 6 weeks and 3 months postoperative. The analysis was completed using the intrahospital software Clinicom, which allowed us to trace all the events and episodes for each patient. Results The early mortality rate was 0%. There were five major complications (4.3%) and thirteen minor complications (11%). The early readmission rate was 5.2%. Homologous blood transfusion was performed in 36% of patients. Administration of tranexamic acid reduced this rate to 24.3% versus 44% in patients not taking it (p = 0.06). Conclusion The perioperative mortality in this selected population is zero and the early morbidity is acceptable. The early readmission rate is also low. Thus proposing single-stage bilateral TKR to patients meeting the criteria defined in this study is a valid strategy. Level of evidence IV, retrospective cohort study.