Is simultaneous bilateral Total Knee Arthroplasty safe in elderly patients above 70 years? A retrospective cohort study of up to 9 years follow up. Dr. Vipul Vijay, Dr (Prof.) Raju Vaishya Deptt. of Orthopaedics, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi. Introduction Materials & Methods Continuous increase in number of elderly population in developed countries with fastest growing age > 85 years old. Population aged >90 years in USA will double from 2 to 4 million from 2010 to 2035. Likely to be associated with a parallel increase in number of TKA done. Elderly people unwilling to undergo TKA as compared to younger counterparts. Advantages of SBTKA as compared to two stage: Shorter time of exposure to anesthesia, Less time spent in hospital, Shorter rehabilitation and physical therapy, Fewer wound complications, Decreased surgical stress, Convenient to family members More cost-effective treatment Post operative complications like – UTI, myocardial ischemia, confusion, respiratory tract infection, DVT with positive scan, shifting to high dependency unit or ICU, implant infection, and repeat surgery noted. Surgery under torniquet PS cemented knee (Scorpio, Stryker) Drain used in all cases Multi-modal DVT prophylaxis used – mechanical & pharmacological Mobilization as per patient comfort Data Analysis Data assimilated by Fellow Average of all continuous data expressed in mean±SD. Pre-operative and post –operative KSS assessed by applying Wilcoxon Signed Ranks test. . Materials & Methods 177 SBTKA between 2003 and 2012. Retrospective cohort study of 46 patients (92 knees) of age >70 years Combined spinal epidural anesthesia (93.5%) or general anesthesia (6.5%). More painful side operated first and 2nd side done during same anesthesia, if no significant events during surgery. <70 years, Undergone staged B/L, U/L or uni compartmental knee arthroplasty, <Ahlback’s grade IV OA Revision TKA All patients had Dobutamine Stress Echo Associated co-morbidities noted. Patient’s age, sex, weight, height, BMI, American Society of Anesthesiologist (ASA) grade, Knee Society Score (KSS), tourniquet time, preoperative and postoperative hemoglobin, peri and post operative complications, length of hospital stay, amount of blood in the drain (in first 24 and 48 hours) after surgery, blood transfusions. Results Mean/number Standard deviation/percentage Age Sex Male Female BMI ASA Grade I Grade II Grade III Grade IV Grade V Preoperative Hb Postoperative Hb Tourniquet time ( in minutes) Postoperative blood loss in drain (ml) 80.13 25 21 29.4 12 8 1 12.6 9.94 44.43 45.56 968.19 5.25 54.4% 45.6% 5.36 26.08% 54.34% 17.4% 2.2% 0% 1.62 1.1 14.01 16.63 495.7 Most common post op complication - delirium Renal dysfunction (2), Angina (2), UTI (2),MI (1). No hospital mortality or till one year after index surgery Average time of death after surgery 5.6 years Exclusion criteria Discussion 24% patients - no significant co-morbidity. 80% ASA grade 1 or 2. Significant improvement in post op KSS. Laskin - in patients >85 years, after TKA 76% could live independently. Ravi et al – TKA in moderate to severe OA found to be associated with significant (40%) reduction in subsequent risks of serious cardiovascular events. Materials & Methods Conclusion SBTKA not associated with any additional or significant increased risk of morbidity or mortality in this study. SBTKA seems a safe, effective, and viable procedure for carefully selected elderly patients.