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Staged versus simultaneous bilateral total knee replacement.

S L Brotherton, J R Roberson, J R de Andrade

    The Journal of Arthroplasty
    |January 1, 1986
    PubMed
    Summary
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    Simultaneous bilateral total knee replacements result in fewer hospital days and lower costs compared to staged procedures. This approach is recommended for suitable patients to optimize outcomes and reduce healthcare expenses.

    Area of Science:

    • Orthopedic Surgery
    • Anesthesiology
    • Health Economics

    Background:

    • Bilateral total knee replacements (TKR) can be performed either simultaneously under one anesthetic or staged under two separate anesthetics.
    • The choice between simultaneous and staged procedures may impact perioperative outcomes, resource utilization, and costs.

    Purpose of the Study:

    • To compare the perioperative course, including operative time, blood loss, complications, hospital stay, and costs, between simultaneous and staged bilateral TKRs.

    Main Methods:

    • Retrospective review of 29 staged and 18 simultaneous bilateral TKR cases (totaling 76 procedures and 94 knees).
    • Comparison of operative time, blood loss, complication rates, hospital length of stay, and estimated hospital bills between the two groups.

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    Main Results:

    • Operative time, blood loss, and complication rates were similar between simultaneous and staged bilateral TKRs.
    • Staged TKRs resulted in significantly longer hospital days (more than double) and an 18% increase in hospital bills compared to simultaneous TKRs.
    • The hospital bill for staged procedures could be over 50% higher per patient.

    Conclusions:

    • Simultaneous bilateral TKRs offer significant advantages in terms of reduced hospital length of stay and lower costs.
    • Simultaneous bilateral total knee replacement is recommended for appropriate patients to improve efficiency and reduce healthcare expenditure.