Clinical Research

Clinical Orthopaedics and Related Research®

, Volume 471, Issue 1, pp 17-25

First online:

Have Bilateral Total Knee Arthroplasties Become Safer?: A Population-Based Trend Analysis

  • Stavros G. MemtsoudisAffiliated withDepartment of Anesthesiology, Hospital for Special Surgery, Weill Medical College of Cornell University Email author 
  • , Carlos B. MantillaAffiliated withDepartment of Anesthesiology, Mayo Clinic
  • , Javad ParviziAffiliated withDepartment of Orthopedics, The Rothman Institute, Jefferson University
  • , Ottokar StundnerAffiliated withDepartment of Anesthesiology, Hospital for Special Surgery, Weill Medical College of Cornell University
  • , Madhu MazumdarAffiliated withDivision of Biostatistics and Epidemiology, Weill Medical College of Cornell University



Studies suggest a trend in the selection of younger and healthier individuals to undergo bilateral TKAs in an attempt to diminish the incidence of complications. It remains unclear whether this development has reduced overall perioperative morbidity and mortality.


We investigated whether changes in demographics and comorbidity patterns of patients undergoing bilateral TKAs are detectable and coincide with changes in length and cost of hospitalization, incidence of perioperative complications, morbidity, and mortality.


We accessed Nationwide Inpatient Survey data files between 1999 and 2008. One-year periods were created and changes in demographics, length of in-hospital stay, and perioperative morbidity and mortality were analyzed.


An estimated 258,524 bilateral TKAs were performed between 1999 and 2008 in the United States. The number of annual procedures increased from 19,288 to 33,679 (75%). Length of hospital stay decreased from 4.98 to 4.01 days. Absolute in-hospital mortality rates decreased at an average rate of 10% per year. The unadjusted percent and adjusted incidence per 1000 inpatient days decreased from 0.42% and 0.85 to 0.16% and 0.39. Although the unadjusted incidence of pneumonia, pulmonary embolism, and nonmyocardial infarction cardiac complications did not change, an increase with time was detectible after adjustment for length of stay. No changes in adjusted incidence were seen for other complications.


Although a decreased incidence was seen for some major complications, others either remained unchanged or had an increased incidence when adjusted for length of stay. Future interventions should focus on reducing perioperative risk to improve patient safety.