Principals of total knee arthroplasty

Indications for simultaneous bilateral TKR
Indications for simultaneous bilateral TKR
Bone preparation
Bone preparation
Soft tissue balancing
Correction of varus deformity
Correction of varus deformity

 Indications for simultaneous bilateral TKR

Cost effectiveness?

58% hospital charges in bilateral

Lane et al., additional rehabilitation in 89% bilateral, 45% unilateral


Infection rate, knee scores, radiographic criteria


Controversy continues..

Blood loss, postop thrombocytopenia at 2nd day, DVT/PTE



Indications for simultaneous bilateral TKR

Fat embolism

Dorr et al., 12% fat embolism syndrome in bilateral TKA

Others, no difference in two groups

Fluted intramedullary alignment rod + Enlarged entrance hole


Comorbidities and physiologic age

>70 yrs old, increased risk of cardiovascular, neurologic complications

No increased risk, BMI>30


4 million hospital discharges over 14 yrs analysis

Complication & mortality rate

Bilateral TKA > unilateral or revision TKA

Bone preparation



Bone preparation

Soft tissue balancing

Coronal balancing

Correction of Varus Deformity

Correction of Valgus Deformity


Sagittal balancing

Correction of Flexion Contracture

Correction of Recurvatum

Correction of Varus Deformity


Extension medial gap

Posterior oblique ligament, Posterior capsule, semimembranosus

Flexion medial gap

Pes anserinus, anterior half of superficial MCL


Correction of Flexion Contracture

Posterior capsule & posterior condylar osteophytes removed

Superior genicular artery!








Gastrocnemius tendinous origin release


Additional distal femoral cut


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