Recovery after Total Knee Arthroplasty: Does one or two knees matter?

Total Knee Arthroplasty (TKA) is an effective surgical intervention for end-stage osteoarthritis (OA). The decision between unilateral TKA and simultaneous bilateral TKA remains a topic of debate due to differences in functional outcomes, complication rates, and recovery trajectories. This study aims to compare the functional recovery, complications, and patient satisfaction between unilateral and simultaneous bilateral TKA in the Indian population.

This prospective, single-surgeon, comparative cohort study included 216 patients (112 unilateral TKA, 104 simultaneous bilateral TKA). Patients were followed for an average of 6.15 ± 1.21 years. Functional outcomes were assessed using the Oxford Knee Score (OKS) and range of motion (ROM) at 1 year and 5 years postoperatively. Pain, complication rates, hospital stay, and patient satisfaction were also evaluated.

Both groups showed significant improvements in OKS and ROM compared to baseline. At 1 year, the OKS improved to 33.12 ± 1.66 (unilateral) and 33.56 ± 1.72 (bilateral) (P-value = 0.028), with further improvement at 5 years (38.65 ± 1.48 vs. 39.14 ± 1.54, P-value = 0.011). ROM improvements were comparable between groups (P-value = 0.787). The bilateral group had a longer hospital stay (P-value = 0.02) and higher early postoperative pain, but overall complication rates and patient satisfaction were similar (P-value = 0.74).

Simultaneous bilateral TKA provides comparable long-term functional outcomes to unilateral TKA, with efficient recovery and similar complication rates. Careful patient selection is essential to optimize outcomes.