ผลลัพธ์ระยะสั้นของการผ่าตัดเปลี่ยนข้อเข่าเทียมพร้อมกันทั้งสองข้างในโรงพยาบาลนครปฐม: เปรียบเทียบในแง่การใช้ระบบนำร่องและรูปแบบข้อเทียม

akraporn sitthitheerarut; wasu Techapaitoon; Paphon Hirunyachoke

Authors

akraporn sitthitheerarut Nakorn Pathom hospital
wasu Techapaitoon Nakorn Pathom hospital
Paphon Hirunyachoke Nakorn Pathom hospital

Abstract

Objective: Simultaneous bilateral total knee arthroplasty (SBTKA) offers potential advantages over staged procedures, yet optimal surgical techniques and implant selection remain debated. This study compared clinical outcomes between navigation-assisted and conventional SBTKA techniques, while evaluating the performance of cruciate-retaining versus posterior-stabilized implants.

Methods: We retrospectively analyzed 133 consecutive SBTKA procedures (266 knees) performed at Nakhonpathom Hospital between August 2020 and June 2025. Patients were categorized into navigation-assisted (NAV-SBTKA; n = 23) and conventional (CON-SBTKA; n = 110) groups. Implant comparisons included cruciate-retaining (CR; n = 40) and posterior-stabilized (PS; n = 70) designs within the conventional group. Primary outcomes included operative parameters, blood loss, transfusion requirements, and Knee Society Scores at three-month follow-up.

Results: Demographic characteristics were comparable between groups. NAV-SBTKA demonstrated significantly longer operative times (217.17 vs. 131.59 minutes; p < .001) and greater hemoglobin decline (2.50 vs. 1.93 g/dL; p = .03) compared to CON-SBTKA. However, both techniques achieved similar postoperative functional outcomes and safety profiles. PS implants required longer operative times, greater blood loss, and higher transfusion rates compared to CR designs (22.9% vs. 5.0%; p = .015). Pre-operative anemia (Hb <12 g/dL) was strongly associated with increased transfusion risk.

Conclusions: Both navigation-assisted and conventional SBTKA techniques demonstrated excellent clinical outcomes with comparable safety profiles. While PS implants increased perioperative blood loss, functional outcomes remained equivalent to CR designs. Pre-operative anemia optimization represents a critical strategy for reducing transfusion requirements, particularly with PS implants.

References

Hong M, Loeb J, Yang M, Bailey J. Postoperative outcomes of a digital rehabilitation program after total knee arthroplasty: Retrospective, observational feasibility study. JMIR Form Res. 2022;6(9):e40703. doi: 10.2196/40703.

Chaudhari Y, Thombare K. Perioperative outcomes of simultaneous bilateral total knee arthroplasty in elderly Indian patients: A retrospective study. J Orthop Case Rep. 2025;15(7):288–94. doi: 10.13107/jocr.2025.v15.i07.5852.

Liu L, Liu H, Zhang H, Song J, Zhang L. Bilateral total knee arthroplasty: Simultaneous or staged? A systematic review and meta-analysis. Medicine (Baltimore). 2019;98(22):e15931. doi: 10.1097/MD.0000000000015931.

Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the knee society clinical rating system. Clin Orthop Relat Res. 1989;(248):13–4.

Bauwens K, Matthes G, Wich M, Gebhard F, Hanson B, Ekkernkamp A, et al. Navigated total knee replacement. A meta-analysis. J Bone Joint Surg Am. 2007;89(2):261–9. doi: 10.2106/JBJS.F.00601.

Cheng T, Zhao S, Peng X, Zhang X. Does computer-assisted surgery improve postoperative leg alignment and implant positioning following total knee arthroplasty? A meta-analysis of randomized controlled trials. Knee Surg Sports Traumatol Arthrosc. 2012;20(7):1307–22. doi: 10.1007/s00167-011-1588-8.

Han SB, Kim HJ, Kim TK, In Y, Oh KJ, Koh IJ, et al. Computer navigation is effective in reducing blood loss but has no effect on transfusion requirement following primary total knee arthroplasty: a meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2016;24(11):3474–81. doi: 10.1007/s00167-016-4053-x.

Zampogna B, Campi S, Torre G, Villari E, Moncada F, Perrino A, et al. Outcomes of computer-assisted total knee arthroplasty compared to conventional TKA: A bicentric controlled retrospective clinical study. J Clin Med. 2021;10(15):3352. doi: 10.3390/jcm10153352.

Kim YH, Park JW, Kim JS. Computer-navigated versus conventional total knee arthroplasty: a prospective randomized trial. J Bone Joint Surg Am. 2012;94(22):2017–24. doi: 10.2106/JBJS.L.00142.

Lombardi AV Jr, Berend KR, Adams JB. Why knee replacements fail in 2013: patient, surgeon, or implant? Bone Joint J. 2014;96-B(11 Suppl A):101–4. doi: 10.1302/0301-620X.96B11.34350.

Ding H, Han D, Ma N, Gao C, Yao J, Ouyang G. Comparison of early clinical outcomes between CR and PS prostheses in total knee arthroplasty for rheumatoid arthritis patients - a retrospective cross-sectional study. Front Surg. 2025;12:1522588. doi: 10.3389/fsurg.2025.1522588.

Mähringer-Kunz A, Efe T, Fuchs-Winkelmann S, et al. Bleeding in TKA: posterior stabilized vs. cruciate retaining. Arch Orthop Trauma Surg. 2015;135(6):867–70. doi: 10.1007/s00402-015-2209-7.

Lozano-Calderón SA, Shen J, Doumato DF, Greene DA, Zelicof SB. Cruciate-retaining vs posterior-substituting inserts in total knee arthroplasty: functional outcome comparison. J Arthroplasty. 2013;28(2):234–42.e1. doi: 10.1016/j.arth.2012.05.010.

Sirimahachai C, Haruthaiborrorux P, Naratrikun K. Functional outcomes of cruciate-retaining and posterior-stabilized total knee arthroplasty: A randomized trial using the two-minute walk and timed up and go tests. JSAO. 2026;50(1):72–7. doi: 10.56929/jseaortho-2025-0270.