Abstract
Background: When patients present with end-stage
bilateral knee arthritis, the decision facing both the
patient and the surgeon is whether to replace both
knees in one sitting (simultaneous bilateral total knee
replacement) SMBTKR or to undertake one knee
replacement and after an interval of time and as a
separate episode, replace the other knee (staged
bilateral total knee replacement) STBTKR. There is
concern regarding the safety of undertaking
SMBTKR. The study is a review to determine the
risk benefit profile of SMBTKR compared to a
staged procedure (STBTKR).
Methods: A literature search of MEDLINE and
EMBASE from inception to April 2019 was carried
out. 26 studies qualified for inclusion in the review. A
systematic review was undertaken using narrative
synthesis. Methodological quality was assessed with
the use of risk of bias tool developed by Warby et al
(2014).
Results: The studies were of moderate quality with
low to moderate risk of bias. There is evidence that
the risk of complications may be increased when
patients with chronic cardiac and pulmonary illness
undergo SMBTKR. There may also be increased risk
of confusion and mortality in the frail elderly patient
(>75yrs). There is increased blood loss with this
approach. Benefits include superior rehabilitation
and functional outcome and lower cost associated
with SMBTKR. Patients not suitable for SMBTKR
are best treated as STBTKR.
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