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One-Stage Versus Two-Stage Bilateral Total Knee Arthroplasty: A Systematic Review and Meta-Analysis.
Alessandro Bensa1, Marco Delcogliano1, Giacomo Moraca2
1Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland; Università della Svizzera Italiana, Faculty of Biomedical Sciences, Lugano, Switzerland.
The Journal of Arthroplasty
|March 16, 2025
Summary
One-stage bilateral total knee arthroplasty (B-TKA) offers fewer complications and shorter hospital stays than two-stage B-TKA. However, it carries a higher risk of mortality and certain adverse events, requiring careful patient selection.
Area of Science:
- Orthopedic Surgery
- Biomedical Engineering
- Clinical Outcomes Research
Background:
- Bilateral total knee arthroplasty (B-TKA) is increasingly utilized for advanced bilateral knee osteoarthritis (OA).
- Comparative data on one-stage versus two-stage B-TKA are crucial for optimizing patient management.
- This systematic review and meta-analysis quantifies and compares outcomes of both surgical approaches.
Purpose of the Study:
- To compare clinical outcomes, perioperative parameters, complications, revisions, and mortality rates between one-stage and two-stage B-TKA.
- To provide evidence-based information for surgical decision-making in bilateral knee OA treatment.
- To assess the trade-offs between procedural efficiency and patient safety in B-TKA.
Main Methods:
- A systematic literature search was performed in PubMed, Cochrane, and Web of Science in February 2024.
- Inclusion criteria focused on comparative studies of one-stage and two-stage B-TKA for bilateral knee OA, with no time restrictions.
- Study quality was assessed using the Cochrane risk of bias tool, including 69 studies with 366,722 patients.
Main Results:
- One-stage B-TKA demonstrated lower TKA-related, deep infection, and wound complication rates, with reduced operative time and hospital stay.
- Patients undergoing one-stage B-TKA showed greater improvements in WOMBAT and Oxford Knee scores.
- Conversely, one-stage B-TKA was associated with higher 1-month, 3-month, and 1-year mortality rates, and increased neurological, gastrointestinal, and thromboembolic complications.
Conclusions:
- One-stage B-TKA presents a trade-off: lower surgical complications and shorter recovery but increased mortality and thromboembolic risk.
- While offering marginal clinical outcome improvements, one-stage B-TKA also elevates risks of neurological and gastrointestinal issues.
- These findings are vital for informed patient and surgeon decisions regarding the optimal B-TKA strategy.
