Simultaneous bilateral total knee and ankle arthroplasty as a single surgical procedure

We present a patient with simultaneous bilateral valgus and patellofemoral OA of the knees and bilateral varus OA of the ankle joints that equally contributed to overall disability. This 63 years old, motivated and otherwise healthy patient was treated by simultaneous bilateral total knee and ankle arthroplasty (quadruple total joint arthroplasty, TJA) during the same anesthesia. Two years outcome showed excellent alignment and function of all four replaced joints. Postoperative time for rehabilitation, back to work (6th week) and hospital stay (12 days) of this special patient was markedly reduced compared to the usual course of separate TJA.Simultaneous quadruple TJA in equally disabling OA of bilateral deformed knees and ankles resulted in a better functional outcome and faster recovery compared to the average reported results after TKA and TAA in literature. However, careful preoperative planning, extensive patient education, and two complete surgical teams were considered essential for successful performance. To the best of our knowledge this is the first case report in literature about quadruple major total joint arthroplasty implanted during the same anesthesia in the same patient.Total joint arthroplasty (TJA) of the knee (TKA) and ankle (TAA) are well established procedures demonstrated to provide good long-term results in terms of reduced pain and increased function [1,2]. In the presence of bilateral osteoarthritis (OA) of the knees and ankles contributing equally to cumulative gait inability in the same patient, surgical treatment of all four joints may be indicated. Surgery can be accomplished in a staged fashion or as a simultaneous procedure under one anesthesia to shorten disability and rehabilitation time that would accumulate with sequential TJA.To our knowledge, there have been no special reports on simultaneous bilateral TAA and outcome was usually incorporated in overall reports on TAA [2]. In contrast, bilateral TKA have been extensively discus