1. Bilateral Simultaneous Total Knee Arthroplasty (SBTKA) in patients above 70 years old
Dr (Prof) Raju Vaishya
(MBBS, MS, MCh, FRCS)
Sr Consultant Orthopaedics & Joint Replacement Surgery
Indraprastha Apollo Hospitals, New Delhi, INDIA

2. Simultaneous Bilateral Total Knee Arthroplasty in elderly greater than 70 years
(Paper number - #886)
Authors:
Raju Vaishya, Vipul Vijay, Kapil Mani KC
Institution:
Indraprastha Apollo Hospitals, N Delhi, INDIA

3. SBTKA in elderly Increasing need for TKAs in elderly
Only few published reports in octogenerians & nonagenarians
The results of SBTKA have not been reported 

4. Problems in Octo & Nonagenarians
Age related physical & medical issues (Hilton et al 2004)
Severe & complex deformities (Zicat et al, 1993)
Associated osteoporosis
Lesser response to rehabilitation
More post-operative assistance required
Total cost of treatment higher (Brander et al, 1997)
Willful neglect of even eligible patients by the family & doctors (Hamel et al 2008)

5. Criteria for selection
Remaining life expectancy (>5yrs)
Enthusiasm of the patient & family members
Willingness to cooperate in rehab post operatively
No major medical co morbidities
Availability of back up medical care facilities

6. Advantages of TKA in elderly
Significant freedom for ADL
Decreased dependence and improved quality of life (Laskin RS, CORR 1999)
Reduction in subsequent risk of serious cardiovascular events (Ravi et al, BMJ 2014)

7. Our experience 177 SBTKA between 2003 and 2012
Retrospective cohort study of 46 patients
(92 knees) of age >70 years
Combined spinal/epidural anesthesia (93.5%) or general anesthesia (6.5%)
More painful side operated first and 2nd side done during same anesthesia

8. Demographics Mean/number Standard deviation/percentage Age Male Female
BMI
ASA
Grade I
Grade II
Grade III
Grade IV
Grade V
Preoperative Hb
Postoperative Hb
Tourniquet time ( in minutes)
Postoperative blood loss in drain (ml)
80.13 25 21
29.4 12 8 1
12.6
9.94
44.43
45.56
968.19
5.25
54.4%
45.6%
5.36
26.08%
54.34%
17.4%
2.2% 0%
1.62
1.1
14.01
16.63
495.7

9. Co-morbidities

10. Results 24% - no significant co-morbidity 80% ASA grade 1 or 2
Significant improvement in post op KSS
No hospital mortality or
till one year after surgery

11. Complications Most common post op complication – delirium.
Renal dysfunction (2), Angina (2), UTI (2),
MI (1).
Average time of death after surgery 5.6 years (none surgery related).

12. How old is old?? These elderly people are a ‘special class’
Healthy life style
Minimal medical problems
Good quality of life

13. How old is old for a SBTKA?
Safe & effective procedure for carefully selected elderly adults
The individuals and family members understand and accept the risks
Should not be deprived of potential benefits of this surgery

14. Conclusions
Biological age is more important than the chronological age
SBTKA cannot add years to the lives,
but can add quality to the remaining years

15. Our oldest couple to undergo Bilateral TKA in a single sitting (makes a record!)

16. THANKS & Welcome to Delhi