International Orthopaedics

, Volume 33, Issue 1, pp 101–104 | Cite as

The relative safety of one-stage bilateral total knee arthroplasty

  • J. C. Luscombe
  • K. Theivendran
  • A. Abudu
  • S. R. Carter
Original Paper


Patients with osteoarthritis of the knee often require bilateral knee replacement before fulfilling their full ambulatory potential. Despite extensive research there is considerable debate about the risks of performing simultaneous bilateral knee replacements under the same anaesthetic. Our aim was to compare the relative short-term morbidity of one-stage bilateral with unilateral total knee arthroplasty in a retrospective, consecutive cohort of patients. Seventy-two bilateral knee replacements were case-matched for age and gender with 144 unilateral knees. One-stage bilateral arthroplasty was associated with increased morbidity with respect to wound (6.0 vs 0.7%; p = 0.003) and deep prosthetic (3.5% vs 0.7 %; p = 0.02) infections, cardiac complications (3.5% vs 0.7%; p = 0.04) and chest infections (7.0% vs 1.4%; p = 0.04). No differences were observed in the mortality rates (p = 0.30) and risk of thrombo-embolism (p = 0.70). We conclude that one-stage bilateral total knee arthroplasty is associated with increased morbidity compared with unilateral knee replacement.


Total Knee Arthroplasty Knee Replacement Total Knee Replacement Cardiac Complication Bilateral Group 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Les patients ayant présenté une ostéoarthrite du genou nécessitent parfois une prothèse du genou bilatérale. Des travaux font état des risques survenant lors de la réalisation d’une prothèse totale unilatérale du genou, risques anesthésiques notamment. Le but de notre étude est de comparer la morbidité à cours terme du remplacement du genou par prothèse unilatérale en un temps d’un côté ou des deux côtés, ceci à propos de l’étude rétrospective d’une cohorte de patients. 72 prothèses totales du genou bilatérales en un temps ont été analysées en terme d’âge, de sexe en comparaison avec 144 prothèses du genou unilatérales. La prothèse totale du genou bilatérale en un temps est associée une augmentation de la morbidité (6.0 vs 0.7% ; p = 0.003) et à un taux d’infection profonde important (3.5% vs 0.7% ; p = 0.02), de même, en ce qui concerne les complications cardiaques (3.5% vs 0.7% ; p = 0.04), les complications pulmonaires (7.0% vs 1.4% ; p = 0.04). Nous n’avons pas observé de différence sur le plan de la mortalité (p = 0.30) de même en ce qui concerne les risques thromboemboliques (p = 0.70). Nous pouvons donc conclure que la prothèse totale du genou bilatérale en un seul temps entraîne une augmentation importante de la morbidité si on l’a compare à la prothèse totale du genou, unilatérale.


  1. 1.
    Alemparte J, Johnson GV, Worland RL et al (2002) Results of simultaneous bilateral total knee replacement: a study of 1,208 knees in 604 patients. J South Orthop Assoc 11:153–156PubMedGoogle Scholar
  2. 2.
    Barrett J, Baron JA, Losina E et al (2006) Bilateral total knee replacement: staging and pulmonary embolism. J Bone Joint Surg 88:2146–2151PubMedCrossRefGoogle Scholar
  3. 3.
    Bould M, Freeman BJ, Pullyblank A, Newman JH (1998) Blood loss in sequential bilateral total knee arthroplasty. J Arthroplasty 13:77–79PubMedCrossRefGoogle Scholar
  4. 4.
    Brotherton SL, Roberson JR, de Andrade JR, Fleming LL (1986) Staged versus simultaneous bilateral total knee replacement. J Arthroplasty 1:221–228PubMedCrossRefGoogle Scholar
  5. 5.
    Cohen RG, Forrest CJ, Benjamin JB (1997) Safety and efficacy of bilateral total knee arthroplasty. J Arthroplasty 12:497–502PubMedCrossRefGoogle Scholar
  6. 6.
    Forster MC, Bauze AJ, Bailie AG et al (2006) A retrospective comparative study of bilateral total knee replacement staged at a one-week interval. J Bone Joint Surg 88:1006–1010Google Scholar
  7. 7.
    Gradillas EL, Volz RG (1979) Bilateral total knee replacement under one anesthetic. Clin Ortho Relat Res 153–158Google Scholar
  8. 8.
    Hardaker WT Jr, Ogden WS, Musgrave RE, Goldner JL (1978) Simultaneous and staged bilateral total knee arthroplasty. J Bone Joint Surg 60:247–250PubMedGoogle Scholar
  9. 9.
    Huang CH, Wang MJ, Chen TL et al (1996) Blood and central venous pressure responses after serial tourniquet deflation during bilateral total knee replacement. J Formos Med Assoc 95:496–499PubMedGoogle Scholar
  10. 10.
    Huotari K, Lyytikainen O, Seitsalo S (2007) Patient outcomes after simultaneous bilateral total hip and knee joint replacements. J Hosp Infect 65:219–225PubMedCrossRefGoogle Scholar
  11. 11.
    Ivory JP, Simpson AH, Toogood GJ et al (1993) Bilateral knee replacements: simultaneous or staged? J R Coll Surg Edinb 38:105–107PubMedGoogle Scholar
  12. 12.
    Kolettis GT, Wixson RL, Peruzzi WT et al (1994) Safety of 1-stage bilateral total knee arthroplasty. Clin Ortho Relat Res 102–109Google Scholar
  13. 13.
    Lane GJ, Hozack WJ, Shah S et al (1997) Simultaneous bilateral versus unilateral total knee arthroplasty. Outcomes analysis. Clin Ortho Relat Res 106–112Google Scholar
  14. 14.
    Leonard L, Williamson DM, Ivory JP, Jennison C (2003) An evaluation of the safety and efficacy of simultaneous bilateral total knee arthroplasty. J Arthroplasty 18:972–978PubMedCrossRefGoogle Scholar
  15. 15.
    Liu TK, Chen SH (1998) Simultaneous bilateral total knee arthroplasty in a single procedure. Int Orthop 22:390–393PubMedCrossRefGoogle Scholar
  16. 16.
    Mangaleshkar SR, Prasad PS, Chugh S, Thomas AP (2001) Staged bilateral total knee replacement—a safer approach in older patients. Knee 8:207–211PubMedCrossRefGoogle Scholar
  17. 17.
    McLaughlin TP, Fisher RL (1985) Bilateral total knee arthroplasties. Comparison of simultaneous (two-team), sequential, and staged knee replacements. Clin Ortho Relat Res 220–225Google Scholar
  18. 18.
    Morrey BF, Adams RA, Ilstrup DM, Bryan RS (1987) Complications and mortality associated with bilateral or unilateral total knee arthroplasty. J Bone Joint Surg 69:484–488PubMedGoogle Scholar
  19. 19.
    Reuben JD, Meyers SJ, Cox DD et al (1998) Cost comparison between bilateral simultaneous, staged, and unilateral total joint arthroplasty. J Arthroplasty 13:172–179PubMedCrossRefGoogle Scholar
  20. 20.
    Ritter M, Mamlin LA, Melfi CA et al (1997) Outcome implications for the timing of bilateral total knee arthroplasties. Clin Ortho Relat Res 99–105Google Scholar
  21. 21.
    Ritter MA, Harty LD (2004) Debate: simultaneous bilateral knee replacements: the outcomes justify its use.Clin Ortho Relat Res 84–86Google Scholar
  22. 22.
    Sliva CD, Callaghan JJ, Goetz DD, Taylor SG (2005) Staggered bilateral total knee arthroplasty performed four to seven days apart during a single hospitalization. J Bone Joint Surg 87:508–513PubMedCrossRefGoogle Scholar
  23. 23.
    Soudry M, Binazzi R, Insall JN et al (1985) Successive bilateral total knee replacement. J Bone Joint Surg 67:573–576PubMedGoogle Scholar
  24. 24.
    Stubbs G, Pryke SE, Tewari S et al (2005) Safety and cost benefits of bilateral total knee replacement in an acute hospital. ANZ J Surg 75:739–746PubMedCrossRefGoogle Scholar
  25. 25.
    Walmsley P, Murray A, Brenkel IJ (2006) The practice of bilateral, simultaneous total knee replacement in Scotland over the last decade. Data from the Scottish Arthroplasty Project. Knee 13:102–105PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • J. C. Luscombe
    • 1
  • K. Theivendran
    • 1
    • 2
  • A. Abudu
    • 1
  • S. R. Carter
    • 1
  1. 1.The Royal Orthopaedic HospitalBirminghamUK
  2. 2.81 Pennine Way, Ashby-de-la-ZouchLeicestershireUK

Personalised recommendations