Abstract

This study aimed to investigate longitudinal changes in left ventricular diastolic function using echocardiography in patients undergoing bilateral total knee arthroplasty (TKA), based on preoperative and long-term follow-up assessments. This retrospective cohort study included patients who underwent bilateral TKA between 2019 and 2025. Of the 583 patients initially screened, only those who had transthoracic echocardiographic examinations both before surgery and 12–18 months postoperatively during routine clinical follow-up were included in the final analysis. Patients with reduced left ventricular ejection fraction, significant valvular heart disease, atrial fibrillation, chronic kidney disease, or clinically relevant rhythm abnormalities were excluded. Echocardiographic examinations were performed by experienced operators using a Philips EPIQ 7 system under standardized imaging conditions. Diastolic function was evaluated using the E/e′ ratio, transmitral E/A ratio, and septal e′ velocity. Longitudinal changes were assessed within the same individuals. For baseline comparison, a control group with similar demographic characteristics and available preoperative echocardiographic data was selected from the same screened population. At long-term follow-up, septal e′ velocity increased from 6.00 ± 1.19 to 6.71 ± 1.03 cm/s, while the E/e′ ratio decreased from 12.2 ± 2.9 to 11.1 ± 2.5 (both p < 0.001). The E/A ratio also increased significantly (p < 0.001), whereas left ventricular systolic function remained unchanged. Regression analysis showed that baseline E/e′ values independently predicted the magnitude of longitudinal changes in diastolic function (p < 0.05). Among patients with available long-term echocardiographic follow-up, bilateral TKA was associated with favorable changes in selected echocardiographic markers of left ventricular diastolic function. The observed decrease in the E/e′ ratio and increase in septal e′ velocity may indicate favorable hemodynamic adaptation during follow-up. Nevertheless, these findings should be interpreted with caution because of the retrospective study design and the potential for selection bias.

Key words: Bilateral total knee arthroplasty, left ventricular diastolic function, echocardiography, diastolic function, hemodynamic adaptation