Simultaneous bilateral total knee replacement: a persistent controversy

Area of Science:

• Orthopedic Surgery
• Arthroplasty Research

Background:

• The efficacy and safety of Simultaneous Bilateral Total Knee Replacement (SBTKR) are subjects of ongoing debate within orthopedic literature.
• Previous studies present conflicting data regarding mortality, morbidity, and cost-effectiveness, with varying patient exclusion criteria complicating comparisons.

Purpose of the Study:

• To review the English-speaking literature on Simultaneous Bilateral Total Knee Replacement (SBTKR) to evaluate its benefits and risks.
• To identify key factors influencing the safety and effectiveness of SBTKR.

Main Methods:

• A comprehensive review of English-speaking literature was conducted to analyze studies on Simultaneous Bilateral Total Knee Replacement (SBTKR).
• Data regarding patient demographics, comorbidities, surgical outcomes, and hospital settings were extracted and synthesized.

Main Results:

• Significant disparities exist in reported mortality and morbidity rates, with many studies excluding medically frail patients, hindering direct comparisons.
• Patient age and comorbidities are frequently identified risk factors for SBTKR.
• The proportion of patients undergoing SBTKR varies widely (3%-70%) across published series.

Conclusions:

• There is no definitive consensus supporting or opposing Simultaneous Bilateral Total Knee Replacement (SBTKR) based on current literature.
• Careful preoperative assessment, strict patient selection protocols, and appropriate clinical settings with high-dependency nursing are essential for safe SBTKR.
• High-throughput surgical units may offer reduced risk for SBTKR procedures.