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Background: Total knee arthroplasty (TKA) is one of the most successful orthopedic surgeries performed in recent decades. However, controversies still exist between conducting simultaneous or staged bilateral TKA. The objective of this study is to conduct a systematic review assessing the clinical outcome associated with simultaneous bilateral and staged bilateral total knee arthroplasty (BTKA). Methods: A search was applied to CNKI, Embase, Medline, and Cochrane central database (January 2000–July 2018). All studies that compared simultaneous bilateral TKA (simBTKA) with staged bilateral TKA (staBTKA) without language restriction were reviewed, and qualities of included studies were assessed using the Newcastle–Ottawa Scale. Data were pooled and a meta-analysis completed. Results: The 18 studies were identified to be eligible. The 18 comparative studies published from 2001 to 2018, covered 73617 participants in the simBTKA group and 61838 in the staBTKA group, respectively. Results of meta-analyses indicated that simBTKA showed a lower risk of deep infection and respiratory complications, but increased mortality, pulmonary embolism (PE), and deep-vein thrombosis (DVT) compared with staBTKA. There were no significant differences in revision, superficial infection, arthrofibrosis, cardiac complications, neurological complications and urinary complications between procedures. Conclusions: Since there are risks and benefits to both procedures, these potential complications must be interpreted in light of each individual patient's needs and concerns. Further research must be conducted, in the form of a randomized clinical trial, to evaluate the outcomes mentioned in this review.

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