Staged Bilateral Total Knee Arthroplasty: When Should the Second Knee be Replaced?

Area of Science:

• Orthopedic Surgery
• Arthroplasty Research
• Systematic Review Methodology

Background:

• Bilateral total knee arthroplasty (BTKA) can be performed simultaneously or staged, with staging often preferred due to patient-specific factors.
• The optimal safe time interval between staged BTKA procedures remains undetermined.
• This systematic review addresses the knowledge gap regarding the ideal interval between staged TKAs.

Purpose of the Study:

• To systematically review existing literature and determine the optimal time interval between the two stages of bilateral total knee arthroplasty (BTKA).
• To analyze the impact of different time intervals on systemic and local complications following staged BTKA.

Main Methods:

• A systematic literature search was conducted on the Pubmed and Scopus databases for studies published between January 1979 and November 2017.
• Publications comparing staged BTKA outcomes with varying time intervals were included, focusing on systemic and local complications.
• Data from 23 studies involving 117,090 patients were extracted and analyzed, with adjustments for patient age.

Main Results:

• A shorter interval (within 30 or 90 days) between staged BTKA was associated with increased risks of myocardial infarction, cardiac complications, deep vein thrombosis, pneumonia, and knee revision.
• Conversely, shorter intervals demonstrated a reduced risk of pulmonary embolism, superficial and deep knee infections, and vascular complications.
• The analysis included data from 117,090 patients across 23 studies.

Conclusions:

• Performing the second TKA within 30 or 90 days of the first in BTKA increases the risk of systemic complications.
• Shorter intervals between staged TKAs may offer benefits by reducing the risk of other specific complications.
• Findings provide valuable information for surgeons counseling patients on the optimal timing for staged bilateral knee replacements.