Comparative study on functional outcome, complication and readmission rate in bilateral simultaneous versus staggered versus staged total knee replacement: a retrospective study

Vishal Ashokraj Pushkarna, A. V. Gurava Reddy


Background: An important source of debate in orthopaedic practices is the choice of performing simultaneously, staggered or staged bilateral total knee arthroplasty (BTKA). Many studies are available which compare bilateral simultaneous vs staged TKA in terms of functional outcome. But still there are no studies which include staggered BTKA (done in a single hospital stay) and compared their functional outcome, associated complication with a 90 days readmission rate.

Methods: A retrospective review of 300 TKAs patients who underwent bilateral TKA. Patients were divided into three groups with 100 patients each in simultaneous, staggered, staged group. We use hospital electronic health records database to compare the complication and readmission rates in all three groups. Functional outcome was evaluated pre-operatively using knee society score (KSS), Western Ontario and McMaster Universities Arthritis Index (WOMAC), Oxford knee score, Kujala score and range of motion.

Results: The study consists of 234 females and 66 males, among which maximum females were in a simultaneous group while male where more in staggered group. Mean age group in our study was 62.25%. ASA score of 3 was significantly more in staged group. Patient in the staggered group had a better KSS and Kujala score with better range of motion and less readmission and complication rate. Simultaneous BTKA had slightly higher complication rate.

Conclusions: This study demonstrates that there is not big significant in functional outcome when comparing simultaneous, staged and staggered bilateral TKA, but still staggered group shows better postoperative functional outcome.


Simultaneous, Staged, Staggered, BTKA

Full Text:



Ritter MA, Harty LD, Davis KE, Meding JB, Berend M. Simultaneous bilateral, staged bilateral, and unilateral total knee arthroplasty: a survival analysis. J Bone Joint Surg Am. 2003;85(8):1532-7.

Restrepo C, Parvizi J, Dietrich T, Einhorn TA. Safety of simultaneous bilateral total knee arthroplasty: a meta-analysis. J Bone Joint Surg Am. 2007;89(6):1220-6.

Memtsoudis SG, Hargett M, Russell LA, Parvizi J, Baril CWL, Stundner O, et al. Consensus statement from the consensus conference on bilateral total knee arthroplasty group. Clin Orthop Relat Res. 2013;471(8):2649-57.

Meehan JP, Danielsen B, Tancredi DJ, Kim S, Jamali AA, White RH. A population-based comparison of the incidence of adverse outcomes after simultaneous-bilateral and staged-bilateral total knee arthroplasty. J Bone Joint Surg Am. 2011;93(23):2203-13.

Hardaker WT, Ogden WS, Musgrave RE, Goldner JL. Simultaneous and staged bilateral total knee arthroplasty. J Bone Joint Surg Am. 1978;60(2):247-50.

Morrey BF, Adams RA, Ilstrup DM, Bryan RS. Complications and mortality associated with bilateral or unilateral total knee arthroplasty. J Bone Joint Surg Am. 1987;69(4):484-8.

Yoon HS, Han CD, Yang IH. Comparison of simultaneous bilateral and staged bilateral total knee arthroplasty in terms of perioperative complications. J Arthroplasty. 2010;25(2):179-85.

Oakes DA, Hanssen AD. Bilateral total knee replacement using the same anaesthetic is not justiļ¬ed by assessment of the risks. Clin Orthop Relat Res. 2004;428:87-91.

Shin YH, Kim MH, Ko JS, Park JA. The safety of simultaneous bilateral versus unilateral total knee arthroplasty: the experience in a Korean hospital. Singapore Med J. 2010;51(1):44-9.

Kim YH, Choi YW, Kim JS. Simultaneous bilateral sequential total knee replacement is as safe as unilateral total knee replacement. J Bone Joint Surg Br. 2009;91(1):64-8.

Gabr A, Withers D, Pope J, Santini A. Functional outcome of staged bilateral knee replacements. Ann R Coll Surg Engl. 2011;93(7):537.