POSTER ABSTRACTS - ISAKOS

and efficacy of simultaneous bilateral revision
TKA.
Methods: This study cohort included 40 knees in
20 patients who underwent simultaneous bilateral
revision arthroplasty for aseptic failure of a total
knee arthroplasty under the same anesthetic. The
study group was compared to two similar control
groups of 40 knees in 20 patients who underwent
staged bilateral total knee revision arthroplasty
and 20 knees in 20 patients who underwent
unilateral total knee revision arthroplasty.
Follow-up averaged 4 (range, 3-5) years in the
study group and 8 (range, 6-12) years in the
control groups. Clinical and radiographic results
were evaluated by the Knee Society rating system.
Results: Average knee scores improved by 41
points for the revision TKA in the study group, 38
points in the staged group, and 39 points in the
unilateral group. Range of motion improved from
8-85 degrees to 2-115 degrees and tourniquet
times averaged 57 minutes (range 37-78 minutes).
There were no lasting adverse cardiovascular or
thromboembolic complications. However, there
was one transient episode of post-operative
confusion that was attributed to fat embolism.
Conclusion: Simultaneous bilateral revision total
knee arthroplasty has a favorable outcome.
Although the need for simultaneous bilateral
revision knee arthroplasty may be rare. It may be
a viable option in carefully selected patients.
Furthermore, these results suggest that this
combined procedure is a safe and favorable
alternative to staged revision total knee
arthroplasty.
E-poster w/ Standard #556
Outcomes of an Arthroscopic Treatment
Regimen for Severe Osteoarthritis of the Knee
J. Richard Steadman, Vail, CO, USA
Arun Ramappa, Vail, CO USA Presenter
Timothy S Bollom, Vail, CO USA
Karen K Briggs, Vail, CO USA
William G Rodkey, Vail, CO USA
Steadman Hawkins Sports Medicine Foundation,
Vail, CO, USA
Introduction: Recently the benefits of arthroscopy
for the treatment of osteoarthritis(OA) of the knee
have been questioned. Although joint
replacement has yielded successful results, many
patients wish to delay this procedure. In addition,
knee arthroplasty at a physiologically young age
has significant long term implications.
Purpose: The purpose of this study was to
evaluate the functional and subjective outcomes
of patients with severe OA of the knee who
underwent a comprehensive arthroscopic
treatment and physical therapy regimen.
Methods: Between August 2000 and November
2001, 90 knees in 81 patients were treated with a
novel arthroscopic regimen. Inclusion criteria
included severe osteoarthritis, as defined by a
Kellgren-Lawrence Score of 3 or 4, and minimum 2
year follow-up. Under anesthesia, prior to
arthroscopy, knees were insufflated with an
average of 170cc of sterile saline (range 120 to
240). The arthroscopic treatment consisted of:
lysis of adhesions, anterior interval
release(interval between patella and tibia),
contouring of cartilage defects to a stable rim,
shaping of meniscus tears to a stable rim, limited
synovectomy, removal of loose bodies, removal of
osteophytes that affected terminal extension, and
careful homeostasis prior to removal of the
arthroscope. This was followed by a strict physical
therapy regimen that included partial weightbearing
post-operatively, early achievement of full
range of motion, and maintenance of patellar
mobility. Exclusion criteria included treatment of
chondral defects with microfracture. All patients
completed a pre-operative questionnaire and
follow-up questionnaire. Failure of the
arthroscopic protocol was defined as knees
requiring arthroplasty due to lack of improvement
in symptoms.
Results: The average patient age was 57 (range 37
to 78), with 51 males and 39 females. Patients
had an average of 1.5 previous surgeries (range 0
to 12). The average pre-operative Lysholm score
was 51 (range 14 to 90) and the average Tegner
activity level was 3 (range 1 to 9). Knees had an
average of 3.4 mm of medial joint space and 6.2
mm of lateral joint space on the AP view. On the
AP view at 45o of flexion, the average medial joint
space was 3.4 mm and the lateral joint space was
4.6 mm. The weight bearing axis (WBA) was
defined as a line between the center of the hip
and center of the talus. The distance between the
point the WBA crosses the knee joint and the
center of the knee was noted. This distance
divided by the width of the compartment that the
WBA intersected was defined as the shift in the
WBA. The average shift in the WBA was 42%
(range 0 to 129%).
Nine knees failed at an average time from
surgery of 24 months (range 17 to 31 months.
There was no difference in any pre-operative