Simultaneous bilateral sequential total knee replacement is as safe as unilateral total knee replacement

Abstract

We wished to determine whether simultaneous bilateral sequential total knee replacement (TKR) carried increased rates of mortality and complications compared with unilateral TKR in low- and high-risk patients. Our study included 2385 patients who had undergone bilateral sequential TKR under one anaesthetic and 719 who had unilateral TKR. There were no significant pre-operative differences between the groups in terms of age, gender, height, weight, body mass index, diagnosis, comorbidity and duration of follow-up, which was a mean of 10.2 years (5 to 14) in the bilateral and 10.4 years (5 to 14) in the unilateral group. The peri-operative mortality rate (eight patients, 0.3%) of patients who had bilateral sequential TKR was similar to that (five patients, 0.7%) of those undergoing unilateral TKR. In bilateral cases the peri-operative mortality rate (three patients, 0.4%) of patients at high risk was similar to that (five patients, 0.3%) of patients at low risk as it was also in unilateral cases (two patients, 1.0% vs three patients, 0.6%). There was no significant difference (p = 0.735) in either the overall number of major complications between bilateral and unilateral cases or between low- (p = 0.57) and high-risk (p = 0.61) patients. Also, the overall number of minor complications was not significantly different between the bilateral and unilateral group (p = 0.143). Simultaneous bilateral sequential TKR can be offered to patients at low and high risk and has an expected rate of complications similar to that of unilateral TKR.

Component alignment in simultaneous bilateral or unilateral total knee arthroplasty

“…Simultaneous bilateral TKA is important for a comfortable life in patients with bilateral gonarthrosis [2][3][4][5][6]. There may be angular differences in component placements in longer surgical procedures, but according to the results of our study there were no differences in component alignment between simultaneous bilateral TKA and unilateral TKA.…”

“…Total knee arthroplasty is a good option for pain relief and improved function in patients with advanced gonarthrosis. Simultaneous bilateral TKA procedures have increased in patients with bilateral involvement in recent years [2][3][4][5][6]. This provides the patient an early return to daily activities [7].…”

Perioperative Morbidity and Mortality of Same-day Bilateral TKAs: Incidence and Risk Factors

“…However, despite potential advantages of the same-day approach, including exposure to the risks of anesthetic only once, one postoperative course of pain, reduced rehabilitation, and an earlier return to baseline function [10,11,23], the safety of same-day procedures has been questioned because of higher morbidity and mortality when compared with unilateral TKAs [15,22]. Several studies have attempted to compare the incidence of complications after same-day bilateral TKAs, staged bilateral TKAs, and unilateral TKAs using single institution databases, large administrative datasets, or meta-analyses [1,6,7,9,14,15,18,22,[26][27][28]. However, there are no randomized trials comparing the safety of these surgical strategies.…”

“…However, there are no randomized trials comparing the safety of these surgical strategies. Because of the diversity of study settings and designs, it is difficult to draw definitive conclusions [1,6,7,9,14,15,18,22,[26][27][28].…”

“…We therefore compared the (1) 30-day mortality, (2) rates of in-hospital complications, (3) in-hospital charges, and (4) risk factors for complications among patients undergoing same-day bilateral TKAs, staged bilateral TKAs during two separate admissions fewer than 3 months apart (staged 0-3), and staged bilateral TKAs where the two admissions were from 3 to 12 months apart (staged [3][4][5][6][7][8][9][10][11][12] at an institution where same-day bilateral TKAs were discouraged for patients with more severe medical comorbidities.…”