Electronic Letters to:

Knee: M. C. Forster, A. J. Bauze, A. G. Bailie, M. S. Falworth, and R. D. Oakeshott A retrospective comparative study of bilateral total knee replacement staged at a one-week interval J Bone Joint Surg Br 2006; 88-B: 1006-1010 [Abstract] [Full text] [PDF]

eLetters: Submit a response to this article

Electronic letters published:

Bilateral Total Knee Replacement; is it also safe in patients older than 75 years?

Feras M M Ya'ish, Singu Mangaleshkar   (15 September 2006)

Bilateral Total Knee Replacement; is it also safe in patients older than 75 years? 15 September 2006
Feras M M Ya'ish, Trauma and Orthopaedic Registrar University Hospital Birmingham, Selly Oak Hospital, Singu Mangaleshkar Send letter to journal: Re: Bilateral Total Knee Replacement; is it also safe in patients older than 75 years? firasyaish2{at}hotmail.com Feras M M Ya'ish, et al.	Sir, The paper by Forster et al compares the outcome of bilateral total knee replacement (TKR) in three groups: simultaneous replacement (age 66 years (51-70)), staged one-week interval replacement within the same admission (age 68 years (48-77)), and replacements performed during separate admissions (age 64 years (41-79)). The results showed low and comparable rates of complications, good clinical outcomes, and no early mortality in all three groups. Previous studies have shown a significant increase in early mortality in TKR in older age groups (> 75 years).1-3 One study has demonstrated a significant increase in mortality in simultaneous bilateral TKR in patients older than 75 years.2 Another study has shown two- to three-fold increased mortality risk in patients older than 70 years.3 Therefore some authors may suggest limiting bilateral simultaneous TKR to younger patients.4 Although Forster et al showed similar morbidity and mortality in the three studied groups, unfortunately they did not address the older patient group (which showed higher mortality in the previous studies2,3) in their comparison. It would have been more conclusive if the study included older age groups, or compared the outcomes of patients below and above 75 years. We think that the conclusions drawn from this article should be limited to younger patients (under 75 years) until a similar comparison is performed on older age groups. F.M.M. Ya'ish, Trauma and Orthopaedic Registrar, S. Mangaleshkar, University Hospital Birmingham, Birmingham, UK. 1. Parvizi J, Johnson BG, Rowland C, Ereth MH, Lewallen DG. Thirty-day mortality after elective total hip arthroplasty. J Bone Joint Surg [Am] 2001;83-A:1524-8. 2. Mangaleshkar SR, Prasad PS, Chugh S, Thomas AP. Staged bilateral total knee replacement - a safer approach in older patients. Knee 2001;8:207-11. 3. Ritter MA, Hary LD. Debate: simultaneous bilateral knee replacements: the outcomes justify its use. Clin Orthop Relat Res 2004;(428):84-6. 4. Dennis DA. Debate: bilateral simultaneous total knee arthroplasty. Clin Orthop Relat Res 2004;(428):82-3.