The Journal of Arthroplasty, Volume 34, Issue 12, 2944 - 2949.e1

Bilateral Simultaneous vs Staged Total Knee Arthroplasty: Minimal Difference in Perioperative Risks

Tsay, Ellen L. et al.


With the rising utilization of total joint arthroplasty, the role of simultaneous-bilateral surgery will have an expanding impact. The purpose of this study is to examine the risks of perioperative complications with this approach in total knee arthroplasty (TKA), to inform shared decision-making.


We reviewed national hospital discharge data from 2005 to 2014 to compare outcomes between simultaneous-bilateral TKAs (sim-BTKAs) and staged-bilateral TKAs (staged-BTKAs). Hierarchical logistic regression analyses were used to adjust for confounders. Outcomes analyzed included mortality, various medical complications, knee infection, and mechanical complications.


This study analyzed 27,301 sim-BTKAs and 45,419 staged-BTKAs. Patients who underwent simultaneous surgery had a statistically significant higher adjusted odds of mortality, cardiac events, thromboembolic events, and complications involving the urinary and digestive systems, and a lower adjusted odds of deep knee infection and hematoma. Thirteen of the 14 complications had overall incidences less than 2% and 1 outcome had an incidence of 3%. The absolute between-group risk difference for any complication was 1% or less.


Sim-BTKAs have a statistically significant increased odds of multiple complications compared to staged-BTKAs. However, the absolute risk differences between these options are minimal and the occurrence of any complication is low.

Level of Evidence

Therapeutic Level III.

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