The Journal of Arthroplasty, Volume 34, Issue 7, 1531 - 1537

Comparing the Safety and Outcome of Simultaneous and Staged Bilateral Total Knee Arthroplasty in Contemporary Practice: A Systematic Review of the Literature

Michael-Alexander Malahias, Alex Gu, Marco Adriani, Jacqueline L. Addona, Michael M. Alexiades, Peter K. Sculco


Although a variety of studies have assessed the outcomes of simultaneous bilateral total knee arthroplasty (BTKA) and staged BTKA, there remains no definitive conclusion regarding the superiority of one technique in terms of safety.


The US National Library of Medicine (PubMed/MEDLINE), EMBASE, and the Cochrane Database of Systematic Reviews were queried utilizing keywords pertinent to BTKA, simultaneous and staged, and clinical or functional outcomes. In order to examine the contemporary relevant literature, studies published prior to 2009 were excluded from our search.


In total, 19 articles met the inclusion criteria and were included in this analysis. The overall quality of the studies included in this review was rated as moderate. Seven of the 19 studies reported no significant differences between the 2 groups in regards to baseline clinical and demographic characteristics (comorbidity index, American Society of Anesthesiologists grade, preoperative clinical subjective scores). Nearly all from these 7 studies with comparable initial characteristics documented no significant differences in the overall complication rates between the 2 groups in addition to no difference in mortality rate, cardiac complications, revision rate, thromboembolic events, and functional outcomes.


In contemporary studies involving comparable baseline demographics (including comorbidity index, American Society of Anesthesiologists grade), there was moderate evidence to show that simultaneous BTKA is as safe as the staged BTKA.

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