Simultaneous Bilateral Total Knee Replacement: A persistent controversy

The Patient’s Age and American Society of Anesthesiologists Status Are Reasonable Criteria for Deciding Whether to Perform Same-Day Bilateral TKA

“…However, the type of TKA, such as SD BTKA or St BTKA, was not identified as a risk factor in this study cohort of patients for whom the type of TKA was chosen based on age and ASA classification. Our findings agree with those of several previous studies reporting that an increased risk for postoperative complications was associated with ASA score of 3 or 4, preoperative cardiovascular disease, and older age [8,15,18,24,[29][30][31][32][33][34][35][36][37]. Our data, together with the data of these previous studies, suggest that if patients are properly selected, the type of BTKA procedure, such as SD BTKA and St BTKA, may not increase the risk of postoperative complications and has a risk comparable to the risk of UTKA.…”

“…Thus, it has been underpowered and subject to a type II error to detect the difference between UTKA and St BTKA. Finally, although the assessment of a patient's ASA status in this study was made by an independent investigator and recent studies reported a moderate inter-rater reliability of ASA scale in clinical practice [38,39], the ASA classification has been reported to be a crude tool and inherently subjective [29,40]. Therefore, this inherent subjectivity which might have potentially influenced patient selection should be considered.…”

Cardiovascular disease predicts complications following bilateral total knee arthroplasty under a single anesthetic

“…However, other studies did not find increased age to be a risk factor for greater mortality [4,8,15,23]. When such controversy persists [20], it is important to try to identify which preoperative patient characteristics can be utilized by the orthopedic surgeon to determine an individual patient's suitability for a simultaneous procedure [21].…”

“…In addition, there is a relative difficulty to keep up the level of surgical competence when performing two TKAs at once. Subsequently, there is not as of yet a consensus whether single anesthetic bilateral TKA is within an acceptable level of safety when compared to staged bilateral TKA [16][17][18][19][20]. Nor is it clear that the ultimate functional outcomes or survivorship of TKAs performed under these two sets of conditions are equivalent [21].…”

Pulmonary circulatory changes after bilateral total knee arthroplasty during regional anesthesia

“…Despite the increase in bilateral TKAs (BTKA) in the United States in the last decade [7], the perioperative safety of this elective procedure remains a subject of debate [8] and its effect on pulmonary hemodynamics remains poorly understood. We undertook a prospective study of the hemodynamic changes of 30 patients undergoing elective, bilateral, single-stage TKA during epidural anesthesia.…”