Outcomes between staged bilateral total knee arthroplasty and simultaneous bilateral total knee arthroplasty: a retrospective cohort study between 2001 and 2022

Abstract

<p>Introduction: In the era of ageing population, a substantial number of patients suffer from osteoarthritis in both knees. Bilateral total knee arthroplasty (TKA) is one of the surgical options to relieve their pain. There are two methods: simultaneous bilateral TKA (SimBTKA) and staged bilateral TKA (StaBTKA). We aim to compare the clinical outcomes of these methods in our institution.<br>Methods: We retrospectively reviewed 2372 patients (SimBTKA:StaBTKA = 772:1600; female:male = 1780:592; mean age of SimBTKA:StaBTKA = 70.4±7.99:66.4±7.50 years, p<0.001) who had undergone bilateral TKA in our institution from 2001 to 2022. Patients were categorised according to their method of surgery. Inclusion criterion was patient undergoing bilateral TKA in our institution. Particularly for SimBTKA, patients were assessed to be medically fit before undergoing SimBTKA by anaesthetists according to their age, ASA status and severity of osteoarthritis. Primary outcome was length-of-stay (LOS) after surgery. Secondary outcomes were 30-day unintended readmission, intensive care unit (ICU) admission and death.<br>Results: Mean total LOS (acute hospital + rehabilitation centre) was shorter in SimBTKA (SimBTKA:StaBTKA = 18.48:22.40 days, p<0.001). Mean LOS in acute hospital was shorter in SimBTKA (SimBTKA:StaBTKA = 7.62:11.86 days, p<0.001). 30-day unintended readmission rate was lower in SimBTKA (SimBTKA:StaBTKA = 2.07%:6.06%, OR=3.04, p<0.001). Differences in ICU admission and death rates were statistically insignificant (p>0.05) among the two groups.<br>Conclusion: SimBTKA had a shorter LOS than StaBTKA, with comparable complication rates among the two groups. Promotion of SimBTKA should be enhanced in medically stable patients, since SimBTKA was able to shorten LOS and reduce expenditure.</p>