The Journal of Bone and Joint Surgery (American). 2007;89:1220-1226.
doi:10.2106/JBJS.F.01353
© 2007 The Journal of Bone and Joint Surgery, Inc.
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Safety of Simultaneous Bilateral Total Knee Arthroplasty

A Meta-Analysis

Camilo Restrepo, MD1, Javad Parvizi, MD, FRCS1, Thomas Dietrich, MD, DMD, MPH2 and Thomas A. Einhorn, MD3

1 Rothman Institute, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107. E-mail address for J. Parvizi: parvj{at}aol.com
2 Department of Biostatistics, Boston University Goldman School of Dental Medicine, 715 Albany Street, Boston, MA 02118
3 Department of Orthopaedic Surgery, Boston University Medical Center, Doctors Office Building, 720 Harrison Avenue, Boston, MA 02118

Investigation performed at the Department of Orthopedic Surgery, Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, and the Departments of Biostatistics and Orthopaedic Surgery, Boston University Medical Center, Boston, Massachusetts

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. A commercial entity (Stryker Orthopaedics) paid or directed in any one year, or agreed to pay or direct, benefits in excess of $10,000 to a research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which one or more of the authors, or a member of his or her immediate family, is affiliated or associated.

Background: The safety of simultaneous bilateral total knee replacement remains controversial. Some studies have demonstrated a higher rate of serious complications, including death, following bilateral procedures, whereas others have suggested no increase in the complication rate. The objective of this meta-analysis was to compare the safety of simultaneous bilateral total knee replacement with that of staged bilateral and unilateral total knee replacements.

Methods: A computerized literature search was conducted to identify all citations, from 1966 to 2005, concerning bilateral total knee replacement. All of the English-language abstracts were obtained. A multistage assessment was then performed to identify articles fulfilling the inclusion criteria for the study. All randomized, prospective studies reporting the outcome of bilateral total knee replacement were included. The details of the reported data were extracted, and an extensive analysis of relevant variables was carried out.

Results: One hundred and fifty published articles were identified, and eighteen that included a total of 27,807 patients (44,684 knees) were included in the meta-analysis. There were 10,930 unilateral total knee replacements, 16,419 simultaneous bilateral total knee replacements, and 458 staged bilateral total knee replacements with at least three months between the operative procedures. The prevalences of pulmonary embolism (odds ratio = 1.8), cardiac complications (odds ratio = 2.49), and mortality (odds ratio = 2.2) were higher after simultaneous bilateral total knee replacement. The prevalence of deep venous thrombosis was lower after simultaneous bilateral total knee replacement, but this difference was not significant. The complication rates after the staged bilateral total knee replacements were similar to those in the patients who had undergone unilateral total knee replacement only.

Conclusions: Compared with staged bilateral or unilateral total knee replacement, simultaneous bilateral total knee replacement carries a higher risk of serious cardiac complications, pulmonary complications, and mortality. The period of time between staged procedures that would eliminate these increased risks could not be determined from this study.

Level of Evidence: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.


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