Comparing simultaneous and staged bilateral total knee arthroplasty: a systematic review and meta-analysis

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering
• Clinical Outcomes Research

Background:

• Bilateral knee osteoarthritis presents surgical options: staged bilateral total knee arthroplasty (StaBTKA) and simultaneous bilateral total knee arthroplasty (SimBTKA).
• StaBTKA is perceived as lower risk, while SimBTKA offers single-stage correction and faster rehabilitation, but its safety is debated.
• Comparative clinical outcome data for these procedures are crucial for informed surgical decision-making.

Purpose of the Study:

• To systematically compare the clinical outcomes of SimBTKA versus StaBTKA.
• To evaluate perioperative risks and benefits associated with each surgical approach.
• To provide evidence-based insights for optimizing treatment strategies in bilateral knee osteoarthritis.

Main Methods:

• Systematic literature search of PubMed, Embase, Cochrane Library, Ovid, and Web of Science (2000-2025).
• Inclusion of observational cohort studies comparing SimBTKA and StaBTKA.
• Meta-analysis of data from 53 studies involving 572,881 patients.

Main Results:

• SimBTKA showed higher short-term mortality (OR 2.35), deep vein thrombosis (OR 1.45), and transfusion needs (OR 4.42).
• StaBTKA was associated with increased superficial and deep infection rates (ORs 0.69 and 0.65, respectively).
• No significant differences were found in revision rates, pulmonary embolism, neurological, or cardiac complications.

Conclusions:

• SimBTKA and StaBTKA possess distinct risk profiles; neither is universally superior.
• SimBTKA is linked to higher short-term mortality and thrombotic events, while StaBTKA carries a greater risk of infection.
• Individualized surgical strategy is recommended, considering patient factors and balancing risks, benefits, and resource utilization.