Simultaneous bilateral total knee arthroplasties - Who decides?

The purpose of the current retrospective review was to compare the results of 1498 patients having 1090 simultaneous bilateral total knee arthroplasti cs and 958 unilateral total knee arthroplasties in a 3-year period, focusin g on perioperative complications, length of hospital stay, and discharge di sposition. Gender, age, diagnosis, and weight were similar between the grou ps. Patients undergoing simultaneous bilateral total knee arthroplasties ha d statistically significant higher amounts of intraoperative blood loss, wi th more patients requiring blood transfusion, and a higher average number o f units of blood transfused compared with patients undergoing unilateral to tal knee arthroplasty. Overall, a significantly higher incidence of gastroi ntestinal complications was reported in patients who had simultaneous bilat eral knee arthroplasties compared with patients who had unilateral knee art hroplasty. Comparing age subgroups within the unilateral group revealed sig nificantly higher incidences of pulmonary, neurologic, cardiac, and genitou rinary complications among patients 80 years or older versus patients young er than 80 years. Patients having simultaneous bilateral arthroplasties who were 80 years or older had significantly higher incidences of pulmonary, n eurologic, and cardiac complications than patients younger than 80 years in that same group. These results suggest that age, not procedure, has a more significant role in the perioperative morbidity of total knee arthroplasty . Based on the results from the current study and previous literature docum enting patient preference, patient satisfaction, efficacy, and outcomes com parable with those of patients having unilateral total knee arthroplasty, t he authors continue to offer patients the option of simultaneous bilateral total knee arthroplasties.