Cost, safety, and rehabilitation of same-stage, bilateral total knee replacements compared to two-stage total knee replacements.

BACKGROUND: Many patients experience bilateral knee osteoarthritis and require bilateral total knee replacement (TKR). Same-stage, bilateral TKR is proposed to be a cost-effective and safe solution compared to two-stage, but conflicting results in the literature are reported. We aim to compare the costs, safety, and rehabilitation performance of patients in same-stage versus two-stage, bilateral TKR with our centre's perioperative protocol. MATERIALS AND METHODS: We retrospectively reviewed 175 patients (95 same-stage, 80 two-stage) who had undergone bilateral TKR in our centre. Patient selection for same-stage, bilateral TKR was strictly protocol-driven and required fulfilment of all criteria, including age < 75 years, American Society of Anesthesiologists (ASA) grade 1 or 2, body mass index (BMI) < 40, and having non-complex arthritis. All patients followed a standardised pre-operative, intra-operative, and post-operative Enhanced Recovery After Surgery (ERAS) protocol. The cost, safety profiles, and rehabilitation outcomes were compared between the same-stage and two-stage groups. RESULTS: The same-stage, bilateral TKR reduced the length of hospital stays by 5.71 days per patient, decreased the operation time by 27.4 min, saved 3.34 (18.6%) physiotherapy sessions, and 3.78 (51.5%) occupational therapy sessions. The same-stage group experienced a higher haemoglobin drop but no significant difference in transfusion percentage, transfusion volume, complication rate, and readmission rate. The two-stage subgroup with anaesthetic risk, age, and BMI similar to the same-stage group showed the same results. Same-stage, bilateral TKR patients experienced no significant difference in final post-operative pain levels and rehabilitation outcomes as two-stage TKR patients. CONCLUSION: This study showed that same-stage, bilateral TKR can reduce costs, with similar safety profiles and rehabilitation outcomes compared to the two-stage, bilateral TKR.

Neurilemmoma of the first branch of the lateral plantar nerve causing tarsal tunnel syndrome.

In this article, the authors report a case of tarsal tunnel syndrome caused by neurilemmoma of the first branch of the lateral plantar nerve, with symptom resolved after excision. A 42-year-old man presented with left medial heel pain radiating to the lateral sole for 6 months. On examination, there was positive Tinel sign over the medial heel with pain radiating to the lateral sole. Ultrasonography and magnetic resonance imaging confirmed the presence of a 1-cm neurogenic tumor inside the tarsal tunnel. Intraoperatively, a 1-cm neurilemmoma was found at the first branch of the lateral plantar nerve inside the tarsal tunnel. The lesion was excised completely with preservation of its fascicle. The symptom resolved completely after the operation.