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Simultaneous Versus Staged Bilateral Total Knee Arthroplasty

A Meta-Analysis Evaluating Mortality, Peri-Operative Complications and Infection Rates

  • Review Article
  • Published:
HSS Journal ®

Abstract

Background

An important source of debate in many orthopaedic practices is the choice of performing simultaneous or staged bilateral total knee arthroplasty.

Questions/Purpose

The objective of this meta-analysis is to compare simultaneous bilateral with staged bilateral total knee arthroplasty for peri-operative complication rates, infection rates and mortality outcomes.

Methods

All relevant citations were retrieved from MEDLINE, EMBASE, COCHRANE databases and the unpublished literature. Included studies were assessed for methodological quality and abstracted data was conducted independently by two reviewers. Data was categorized into subgroups and pooled using the DerSimonian and Laird’s random effects model.

Results

A total of 18 articles were identified from 873 potentially relevant titles and selected for inclusion in the primary meta-analyses. The incidence of mortality was significantly higher in the simultaneous group at 30 days (RR [relative risk] 3.67, 95% confidence interval [CI] 1.68–8.02, p = 0.001, I 2 = 59%, n = 67,691 patients), 3 months (RR 2.45, 95% CI 2.15–2.79, p < 0.00001, I 2 = 0%, n = 66,142 patients) and 1 year (RR 1.85, 95% CI 1.66–2.06, p < 0.001, I 2 = 0%, n = 65,322 patients) after surgery. However, there were no significant differences between the two groups in regards to in-hospital mortality rates (R 1.18, 95% CI 0.74–1.88, p = 0.48, I 2 = 0%, n = 33,814 patients). In addition, there was no increased risk of deep vein thrombosis, cardiac complication, and pulmonary embolism or infection rates in either comparison group.

Conclusions

The results of the analysis suggest that simultaneous bilateral total knee arthroplasty has a significantly higher rate of mortality at 30 days, 3 months and 1 year after surgery, but similar infection and complication rates in comparison to staged bilateral total knee arthroplasty.

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Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements) that might pose a conflict of interest in connection with the submitted article. One or more of the authors has or will received payments from a commercial entity that may be perceived as a potential conflict of interest. One or more of the authors’ institution has or will received payments from a commercial entity that may be perceived as a potential conflict of interest.

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Authors and Affiliations

  1. McMaster University, 293 Wellington Street North, Suite 110, Hamilton, Ontario, Canada, L8L 8E7

    Nasir Hussain BSc, Teresa Chien BSc, Farrah Hussain BSc, Ammar Bookwala, Nicole Simunovic MSc & Mohit Bhandari MD, PhD, FRCS(C)

  2. Hiranandani Orthopaedic Medical Education (HOME), Orthopaedic Division of Dr. LH Hiranandani Hospital, Powai, Mumbai, India

    Vijay Shetty MS (Orth)

Authors
  1. Nasir Hussain BSc
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  2. Teresa Chien BSc
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  3. Farrah Hussain BSc
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  4. Ammar Bookwala
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  5. Nicole Simunovic MSc
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  6. Vijay Shetty MS (Orth)
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  7. Mohit Bhandari MD, PhD, FRCS(C)
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Corresponding author

Correspondence to Mohit Bhandari MD, PhD, FRCS(C).

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Level of Evidence: Therapeutic Study Level IV. See levels of evidence for a complete description.

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Hussain, N., Chien, T., Hussain, F. et al. Simultaneous Versus Staged Bilateral Total Knee Arthroplasty. HSS Jrnl 9, 50–59 (2013). https://doi.org/10.1007/s11420-012-9315-7

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  • DOI: https://doi.org/10.1007/s11420-012-9315-7

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