The Ideal Timing of Bilateral Total Knee Arthroplasty: Simultaneous Versus Staged

Document Type : RESEARCH PAPER


Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA



Objectives: The ideal timing for patients undergoing bilateral total knee arthroplasty (TKA) remains 
unknown. The purpose of this study was to compare 90-day outcomes between unilateral, simultaneous 
bilateral, and staged bilateral TKA.
Methods: The PearlDiver database was used to retrospectively identify 231,119 patients undergoing primary TKA 
during 2015-2020, of which 67,956 (29.4%) were bilateral. Bilateral TKA patients were divided into cohorts of 
simultaneous bilateral TKA and staged bilateral TKA at 1-14 days, 15-30 days, 31-90 days, and 91-365 days. Each 
bilateral TKA cohort underwent one-to-one matching with unilateral TKA patients based on age, gender, year, 
Elixhauser Comorbidity Index (ECI), and a history of obesity, diabetes, and tobacco use. Ninety-day outcomes were
compared between matched groups via univariate and multivariate analysis. In staged bilateral TKA groups, 
outcomes were collected beginning after the second TKA.
Results: Compared to unilateral TKA, simultaneous bilateral TKA was associated with higher rates of venous 
thromboembolism (VTE; odds ratio [OR] 1.28, 95% confidence interval [CI] 1.07-1.54, p=0.007), acute kidney injury 
(AKI; OR 1.47, CI 1.17-1.84, p=0.001), blood transfusion (OR 6.81, CI 5.43-8.65, p<0.001), and any complication 
(OR 1.63, CI 1.49-1.78, p<0.001). Staged bilateral TKA at any time interval studied was associated with a similar or 
decreased risk of individual complications, emergency department visits, readmissions, reoperations, and any 
complication relative to unilateral TKA.
Conclusion: Simultaneous bilateral TKA is associated with an increased risk of adverse events compared to 
unilateral TKA. However, bilateral TKA staged at a short interval appears safe in appropriately selected patients.
 Level of evidence: III


Main Subjects

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