Comparison of functional outcome of simultaneous and staged bilateral total knee arthroplasty : systematic review of literature

Abstract

Safety of simultaneous bilateral TKA (simBTKA) and staged BTKA (staBTKA) have been compared in previous systematic reviews but functional outcome remains neglected aspect of the debate. We performed a systematic review of contemporary literature to compare the functional outcome of simBTKA and staBTKA. We searched PubMed/MEDLINE, EMBASE and Cochrane Central Database to identify all articles published between 2000 and July 2020 that evaluated the outcome of patients undergoing BTKA either in simultaneous or staged manner. Ten articles were identified which met the inclusion criteria. Functional outcome was reported in terms of Knee Society score (KSS), range of motion (ROM), Oxford Knee Score (OKS) and Western Ontario and McMaster University score (WOMAC) in seven, five, four and two studies respectively. KSS gained on average 66.6 points (47.5-95.3) for simBTKA and 65.1 points (44.4-97.2) for staBTKA without significant difference between two groups. There was no difference in post-operative ROM (maximum post-operative flexion being 124.4 and 125.1 for simBTKA and staBTKA groups respectively). Mean improvement in OKS ranged from 20 to 32.6 for simBTKA and 21.6 to 33.1 for staBTKA. There was moderate evidence to suggest that both simultaneous BTKA and staged BTKA produce equivalent improvement in functional scores.

Bilateral Total Knee Arthroplasty

“…Leonard et al reported that 95% of patients who underwent simultaneous BTKA would opt for the same surgery again at the 3-year follow-up 82 . Overall, the existing literature indicates that patients undergoing simultaneous BTKA have comparable or better functional outcomes and patient-reported measures than those undergoing staged BTKA or unilateral BTKA with respect to postoperative range of motion 83 , stiffness 84 , Oxford Knee Score (OKS) 85 , Knee Society Score 86 , Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) 84 , 7-year and 10-year survivorship 76,82,87 , and the 36-Item and 12-Item Short Form Health Surveys 86,88 .…”

Clinical Outcomes and Complications of Simultaneous or Sequential Bilateral Total Ankle Arthroplasty

“…Bilateral hip and knee arthroplasties have been extensively studied, including case series of bilateral arthroplasty, comparison of bilateral arthroplasty with unilateral arthroplasty, and direct comparisons of bilateral simultaneous and sequential THA 1-6 , TKA [6][7][8][9][10] , and UKA [11][12][13][14] . The systematic reviews and meta-analyses have summarized that bilateral simultaneous TKA results in a lower risk of deep infection and respiratory complications but increased 30-day mortality, pulmonary embolism, and blood transfusion rates compared with bilateral sequential TKA [25][26][27] . There is moderate evidence to suggest equivalent improvement in functional outcomes 27 .…”

“…The systematic reviews and meta-analyses have summarized that bilateral simultaneous TKA results in a lower risk of deep infection and respiratory complications but increased 30-day mortality, pulmonary embolism, and blood transfusion rates compared with bilateral sequential TKA [25][26][27] . There is moderate evidence to suggest equivalent improvement in functional outcomes 27 . Similarly, in a systematic review of 8 studies, simultaneous bilateral UKA was shown to effectively reduce the operative time, length of stay, and hospital cost without increasing postoperative complications compared with staged bilateral UKA 28 .…”

Comparison of safety and efficiency between sequential simultaneous bilateral and staged bilateral total knee arthroplasty at a high-volume center: a retrospective cohort study

“…StaBTKA means two separate efforts for operations, two painful postoperative periods, and being distanced from work for both patients and their families. The functional outcomes of simBTKA patients have been reported to be comparable to staBTKA 8 . One study reported that 98% of patients with bilateral knee osteoarthritis would prefer simBTKA when given a choice of either simBTKA or staBTKA 9 .…”