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Staged Versus Simultaneous Bilateral Knee Arthroplasty: Does Minimal Cost Difference Justify Risks?

Thomas J Pumo1, Ahmed K Emara1, Yuxuan Jin1

  • 1Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.

The Journal of Arthroplasty
|April 10, 2022
PubMed
Summary
This summary is machine-generated.

Simultaneous bilateral total knee arthroplasty (BTKA) offers shorter stays and lower costs but has higher readmission risks. Staged BTKA provides similar 1-year outcomes with better safety and lower costs.

Keywords:
complicationspatient-reported outcomessafetysimultaneous bilateral total knee arthroplastystaged bilateral total knee arthroplasty

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Area of Science:

  • Orthopedic Surgery
  • Arthroplasty
  • Biomedical Engineering

Background:

  • Bilateral total knee arthroplasty (BTKA) can be performed simultaneously or staged.
  • Simultaneous BTKA may offer faster recovery and cost savings but carries higher risks.
  • This study compares simultaneous versus staged BTKA regarding healthcare utilization, costs, and patient outcomes.

Purpose of the Study:

  • To compare healthcare utilization and surgical supply costs between simultaneous and staged bilateral total knee arthroplasty (BTKA).
  • To evaluate 1-year improvements in patient-reported pain, function, and quality of life (QOL) after simultaneous versus staged BTKA.
  • To determine the safety profiles and cost-effectiveness of both surgical approaches.

Main Methods:

  • A prospective cohort study included 198 simultaneous and 625 staged BTKAs (2016-2020).
  • Propensity score matching created a comparable cohort (198 simultaneous vs. 396 staged BTKAs).
  • Outcomes assessed included length of stay, discharge disposition, readmission, reoperation, surgical costs, and KOOS scores (pain, function, QOL).

Main Results:

  • Simultaneous BTKA had shorter lengths of stay but higher nonhome discharge and 90-day readmission rates.
  • Surgical supply costs were slightly lower for simultaneous BTKA compared to staged procedures.
  • No significant differences were observed in 1-year improvements in pain, function, or QOL between simultaneous and staged BTKA.

Conclusions:

  • Staged bilateral total knee arthroplasty (BTKA) demonstrates a comparable 1-year patient-reported outcome profile to simultaneous BTKA.
  • Staged BTKA offers a better safety profile with lower readmission rates.
  • While simultaneous BTKA shows marginal cost savings, staged BTKA presents a more favorable balance of outcomes, safety, and cost.