ing tourniquets up on both knees at the same time.
So my standard practice is to do one side first, let the tourniquet
down and take care of the deep closure. Then my team takes over and
finishes closing the first side, while I start on the second side. I usually
have the second knee in by the time they finish. That way, I save about
a half hour, and the whole operation usually ends up taking about 2
hours.
The right attitude
It's amazing how far we've come in the last 15 years or so with our
less-invasive surgical techniques and our improved anesthesia and
pain control. At the turn of the century, a bilateral knee operation was
a magnum opus. Now it's pretty routine.
Could it even end up being an outpatient procedure? That would be
a challenge. I want to be able to watch my bilateral patients for a day
or two. On the other hand, it might actually be doable in a 23-hour and
59-minute outpatient environment. Of course, you'd have to be talking
about a younger patient, and one who's both very fit and very motivat-
ed, and that's a small percentage of patients. Then again, think how
far we've come in the last 15 years. What might the next 15 bring?
OSM
9 6 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • O C T O B E R 2 0 1 7
Dr. Sculco (tpstkr@aol.com) is Surgeon in Chief Emeritus at the Hospital for
Special Surgery in New York and a professor of orthopedic surgery at Weill
Cornell Medical College.
