The present study investigates the clinical and radiographic outcomes in patients with all 4 major lower extremity joints replaced.
A retrospective review of our institution's database identified 125 patients in whom both hips and both knees were replaced. The mean time between the first and last arthroplasty was 6.6 years. Preoperative diagnoses included osteoarthritis in 80% and rheumatoid arthritis in 20%. The average age at the time of the first arthroplasty was 63.7 years. The mean follow-up for all arthroplasties was 10.5 years (range 2-31 years). Patients were then matched according to age, gender, diagnosis, prosthesis, and follow-up, to patients with single or bilateral total hip or total knee arthroplasty.
There were 11 aseptic hip revisions (4.4%) and 3 aseptic knee revisions (1.2%). At final follow-up, 86% of hips and 83% of knees were rated with no or mild pain, 68% of patients rated walking as unlimited, and 98% of patients were able to satisfactorily negotiate stairs. Aseptic survivorship for all joint arthroplasties was 93.8% at 15 years. No statistical differences were noted in pain, function, stair, and walking scores between the matched groups.
This report demonstrated excellent clinical, functional, and radiographic outcomes in patients with all 4 major lower extremity joints replaced. Walking aids were needed in 15% of patients, however. At final follow-up, this selected group of patients appears to fare just as well as patients with single or bilateral hip or knee arthroplasty with respect to pain and function.