in the best interests of my patients.
The right patients
The other side of the coin is that it's a bigger operation and a bigger
hit to the system, so there's always a higher chance of a cardiac event
or some other morbidity associated with bigger procedures. That's
why patient selection is extremely important.
At the Hospital for Special Surgery, we've spent a lot of time defining
the population of patients whom we consider ideal bilateral candi-
dates. In 2012, I convened a consensus panel of cardiologists, anesthe-
siologists, orthopedic surgeons and others to agree on some guide-
lines. We spent a day holed up in a room talking about who fit and who
didn't. The consensus: Rehabilitation is challenging, and the medical
risks are greater, so we need to make sure we're working with a
healthier population. We published a consensus statement
(osmag.net/4zknbd) that details 11 conditions under which, we feel,
bilateral TKAs aren't appropriate. Poor candidates include patients
with heart or lung issues, patients with poorly controlled diabetes,
patients who are morbidly obese and patients over age 75.
But once we implemented the guidelines, we were able to achieve
complication and infection rates that were lower than those of
patients having just one knee replaced. In other words, it's possible to
stratify patients in such a way that you significantly reduce morbidity.
The right preparation
I always schedule my bilaterals first thing in the morning. The goal is
to get patients comfortable enough by the end of the day to sit up, or
even stand and take a few steps. By the second day they're ready to
be seen by physical therapy 3 times, and they're up and walking.
To achieve that level of pain control and function, we've implemented
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