SAFETY OF 1-STAGE BILATERAL TOTAL KNEE ARTHROPLASTY

Bilateral total knee replacements during a single operation with intra medullary femoral guide rods have been associated with the possible de velopment of a fat embolism syndrome. To assess the safety of this pro cedure, in which the femoral canal was decompressed by the use of an o verdrilled entrance hole and fluted guide rod, 17 unilateral and 18 bi lateral consecutive total knee patients were evaluated, There were no differences between the groups on the basis of changes in chest radiog raphs, percentage of estimated pulmonary shunting, mental status chang es, or fat and bone marrow elements drawn from a central venous cathet er in the right atrium. Although no patient had free fat in the blood, bone marrow elements were found in 3 bilateral and 2 unilateral cases . No patient had clinical manifestations of a fat emboli syndrome. Wit h appropriate femoral canal decompression, bilateral 1-stage total kne e replacement appears to be a safe procedure.