Total Knee Arthroplasty: Unilateral, Simultaneous Bilateral or Staged Bilateral in Advanced Age?

Abstract

Introduction: Most people with arthritic knees often present with symmetrical joint involvement, a condition often requiring surgery for both knees. There are, however, some disagreements concerning whether or not total knee arthroplasty should be performed simultaneously or in stages. This study aimed to evaluate the length of hospital stay, the need for erythrocyte suspension transfusion, the need for intensive care, and the mortality rates of the patients who underwent unilateral, simultaneous bilateral, and staged bilateral total knee arthroplasty. Materials and Methods: This retrospective study included 1,129 patients, who were divided into three groups based on whether they underwent unilateral, simultaneous bilateral, or staged bilateral total knee arthroplasty, and they were evaluated in terms of hospital stay, erythrocyte suspension transfusion needs, intensive care needs, and mortality rates. Results: Of all the patients, 85.5% were women, with the mean age of 67.58±7.23 years; and 75.6% of them underwent unilateral, 19.9% underwent simultaneous bilateral, 4.5% had staged bilateral total knee arthroplasty, 8.8% required ICU care, and 5 patients died. The need for erythrocyte suspension transfusion and length of hospital stay were highest in those who underwent staged bilateral knee arthroplasty surgery, while it was lowest in those who underwent simultaneous bilateral total knee arthroplasty surgery (all p<0.001). There was no statistically significant difference in terms of the need for intensive care need, length of stay in intensive care unit and mortality rates between patients who underwent unilateral, simultaneous bilateral, and staged bilateral total knee arthroplasty. Conclusion: Simultaneous bilateral total knee arthroplasty may be preferred in younger patients with bilateral knee osteoarthritis but without risky comorbidities, just as we practiced in our clinic. Keywords: Osteoarthritis, Knee; Arthroplasty, Replacement, Knee; Mortality