Simultaneous Versus Staged Bilateral Total Knee Arthroplasty Save

This metanalysis from 2013 reports on an important issue for orthopedists and rheumatologists alike. The issue being in those who need bilateral total knee arthroplasty, is it better to do both knees at once or to do one at a time (staged, serial) arthroplasties..

The metanalysis identified 18 articles that included over 65,000 patients.

The incidence of mortality was significantly higher in the simultaneous group at 30 days (RR 3.67, 95% CI 1.68–8.02), 3 months (RR 2.45, 95% CI 2.15–2.79) and 1 year (RR 1.85, 95% CI 1.66–2.06) after surgery.

On the other hand there were no significant differences between the two groups with regard to in-hospital mortality R 1.18, 95% CI 0.74–1.88), post-operative deep vein thrombosis, cardiac complications, and pulmonary embolism or infection rates

Thus the higher mortality rate associated with bilateral total knee arthroplasty should impact patient selection for this surgical option.  The good news is that there is no differences in other common complications associated with arthroplasty - infection, thrombotic events, etc.