Simultaneous bilateral total knee arthroplasty may be safe in selected patients

Simultaneous bilateral total knee arthroplasty (TKA) provides advantages in the form of single anaesthesia, lower cost, and faster overall rehabilitation for patients suffering from bilateral knee pathologies. However, there are concerns regarding the safety of performing simultaneous bilateral TKA. The present study was aimed at comparing the perioperative outcomes of patients undergoing simultaneous and staged bilateral TKA.

A total of 1696 patients (3392 knees) suffering from bilateral knee arthritis who either underwent a simultaneous (n = 1025) or staged TKA (n = 671) at a single institution were identified retrospectively from our institutional database. Major and minor complications within 90 days of the procedure were compared between simultaneous and staged procedures.

Patients undergoing simultaneous surgery were younger (P < 0.001), had lower ASA score (P < 0.001), and had a lower number of comorbidities (P < 0.001). Overall, complications were comparable in both the groups (staged vs. simultaneous: 17.9% vs. 17.3%, P = 0.794). But after adjusting for the baseline differences, the simultaneous group had a higher risk of complications. When subgroup analysis was performed, in patients younger than 65 years simultaneous surgery did not increase the risk of complications while the risk was almost doubled in patients above 70 years.

Patients undergoing simultaneous bilateral surgery had an increased risk of complications especially when it was performed in patients over 70 years old. Bilateral simultaneous TKA may be safely performed in patients younger than 65 years. In those patients between 65 and 70 years, the slightly increased risk should be discussed with the patient if simultaneous surgery is being considered.