Bilateral Simultaneous vs Staged Total Knee Arthroplasty: Minimal Difference in Perioperative Risks.

Area of Science:

• Orthopedic Surgery
• Arthroplasty Research
• Patient Safety

Background:

• Total joint arthroplasty, including total knee arthroplasty (TKA), is increasingly common.
• Simultaneous-bilateral TKA (sim-BTKA) is a growing surgical approach.
• Understanding perioperative risks is crucial for informed patient decisions.

Purpose of the Study:

• To compare perioperative complication risks between simultaneous-bilateral TKAs (sim-BTKAs) and staged-bilateral TKAs (staged-BTKAs).
• To provide data for shared decision-making regarding bilateral knee replacement surgery.

Main Methods:

• National hospital discharge data from 2005-2014 were analyzed.
• Outcomes for sim-BTKAs were compared to staged-BTKAs.
• Hierarchical logistic regression adjusted for confounders, analyzing mortality, medical, infectious, and mechanical complications.

Main Results:

• The study included 27,301 sim-BTKAs and 45,419 staged-BTKAs.
• Sim-BTKAs had higher adjusted odds of mortality, cardiac, thromboembolic, urinary, and digestive complications.
• Sim-BTKAs showed lower odds of deep knee infection and hematoma, with minimal absolute risk differences (<1%).

Conclusions:

• Sim-BTKAs are associated with a statistically significant increase in certain perioperative complications versus staged procedures.
• Despite increased odds, the absolute risk differences are small, and overall complication rates remain low for both approaches.
• These findings aid in counseling patients considering bilateral knee replacement surgery.