Case Study: Simultaneous bilateral knee replacement in a 54 year old female

A 54-year old female who works at the university in an administrative role who was referred with bilateral knee arthritis. She had suffered from bilateral knee pain for a number of years, and had managed this pain well with regular cortisone injections into each knee in a staggered fashion. However, her most recent injections had held markedly reduced benefit. She is unable to take oral NSAIDs as she has suffered from stomach pains in the past whilst taking them. She had previously obtained knee braces that did provide her with some relief, but she found that, as her pain worsened, she needed to wear them for longer and longer periods of time, and did not tolerate this well. A previous course of physiotherapy yielded no benefit for her.

She had no major medical history, save for Gastric Reflux, and no medication allergies. She is a non-smoker.

Her knee examination revealed mild varus alignment in both knees, fully correctible to neutral. Her BMI was 38. No other remarkable findings were observed.

Her X-rays revealed bilateral varus osteoarthritis of approximately equal severity in each knee.

We counselled Mrs. DP regarding her options, explaining that she had exhausted the non-operative modalities of managing knee OA, and was left with Total Knee Replacement surgery as her only remaining reliable option. We also explained that we felt she would be a candidate for simultaneous bilateral Total Knee Replacement if she so wished.

She elected to have both knees replaced under the same anaesthetic, and we did perform both replacement procedures, one immediately following the other under the same spinal anaesthetic.

Although we initially found controlling Mrs. DP’s pain a challenge (a common scenario in simultaneous bilateral knee replacement patients), we did eventually bring her pain levels under control. Once we had done so, she recovered well and was up walking the day after her surgery.

She was discharged from hospital 2 days after her operation, and was back at work at 6 months post-op. She is now ambulating well without pain, and is happy to have only had to undergo one anaesthetic for both her knees.

Pre-op

Post-op