Clinical safety and efficacy of simultaneous bilateral total knee arthroplasty in an Asian population: a propensity score-matched analysis
Abstract Background Clear clinical guidelines on performing simultaneous bilateral total knee arthroplasty (BTKA) are lacking. We compare the clinical outcomes between BTKA and unilateral total knee arthroplasty (UTKA) using propensity score matching to assess safety and clinical efficacy, hypothesi...
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BMC
2025-05-01
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| Series: | Journal of Orthopaedic Surgery and Research |
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| Online Access: | https://doi.org/10.1186/s13018-025-05933-7 |
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| author | Kwan Kyu Park Hyuck Min Kwon Byung Woo Cho Tae Sung Lee Woo-Suk Lee Jun Young Park |
| author_facet | Kwan Kyu Park Hyuck Min Kwon Byung Woo Cho Tae Sung Lee Woo-Suk Lee Jun Young Park |
| author_sort | Kwan Kyu Park |
| collection | DOAJ |
| description | Abstract Background Clear clinical guidelines on performing simultaneous bilateral total knee arthroplasty (BTKA) are lacking. We compare the clinical outcomes between BTKA and unilateral total knee arthroplasty (UTKA) using propensity score matching to assess safety and clinical efficacy, hypothesizing no difference in clinical safety. Methods Among 1,665 BTKA and UTKA cases, patients were matched in a 1:1 ratio by age, sex, body mass index, follow-up, and comorbidities, resulting in 653 patients per group. Primary outcomes included 30-day complication rates and intensive care unit (ICU) admission rates. Secondary outcomes included length of stay (LOS), transfusion rate, estimated blood loss, hemoglobin (Hb) levels (preoperative and two days postoperative), Hb decrease, and 1-year mortality rate. The patient-reported outcomes (PROMs) was measured preoperatively and at 3, 6, and 12 months postoperatively using the American Knee Society Score, Western Ontario and McMaster Universities Osteoarthritis Index, and EuroQol 5-Dimension. Results There were no differences in the 30-day complication rates and ICU admission rate between the BTKA and UTKA groups after matching (1.4% vs. 0.9%; p = 0.60, 0.5% vs. 0.6%; p = 1.00). However, patients who underwent BTKA had a longer LOS, a higher incidence of transfusion (7.2% vs. 2.1%; p < 0.001), greater blood loss (128.6 ± 75.5 vs. 72.5 ± 45.6 mL; p < 0.001), and a more pronounced decrease in Hb levels (3.1 vs. 2.9 g/dL; p < 0.001) than those who underwent UTKA. No significant differences were observed in PROMs at one year postoperatively. Conclusions Patients who underwent BTKA reported similar 30-day complication rates, ICU admissions, and PROMs compared to UTKA. Despite higher LOS, transfusion rates, blood loss, and Hb decrease, BTKA remains a safe, effective option. It should be performed cautiously, considering patient comorbidities and overall health in treating bilateral knee OA. |
| format | Article |
| id | doaj-art-d34f7b2390b349948ffab5cd9a6aa7ae |
| institution | DOAJ |
| issn | 1749-799X |
| language | English |
| publishDate | 2025-05-01 |
| publisher | BMC |
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| series | Journal of Orthopaedic Surgery and Research |
| spelling | doaj-art-d34f7b2390b349948ffab5cd9a6aa7ae2025-08-20T03:08:43ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2025-05-012011810.1186/s13018-025-05933-7Clinical safety and efficacy of simultaneous bilateral total knee arthroplasty in an Asian population: a propensity score-matched analysisKwan Kyu Park0Hyuck Min Kwon1Byung Woo Cho2Tae Sung Lee3Woo-Suk Lee4Jun Young Park5Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of MedicineDepartment of Orthopaedic Surgery, Severance Hospital, Yonsei University College of MedicineDepartment of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of MedicineDepartment of Orthopaedic Surgery, Heung-K HospitalDepartment of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of MedicineDepartment of Orthopaedic Surgery, Yongin Severance Hospital, Yonsei University College of MedicineAbstract Background Clear clinical guidelines on performing simultaneous bilateral total knee arthroplasty (BTKA) are lacking. We compare the clinical outcomes between BTKA and unilateral total knee arthroplasty (UTKA) using propensity score matching to assess safety and clinical efficacy, hypothesizing no difference in clinical safety. Methods Among 1,665 BTKA and UTKA cases, patients were matched in a 1:1 ratio by age, sex, body mass index, follow-up, and comorbidities, resulting in 653 patients per group. Primary outcomes included 30-day complication rates and intensive care unit (ICU) admission rates. Secondary outcomes included length of stay (LOS), transfusion rate, estimated blood loss, hemoglobin (Hb) levels (preoperative and two days postoperative), Hb decrease, and 1-year mortality rate. The patient-reported outcomes (PROMs) was measured preoperatively and at 3, 6, and 12 months postoperatively using the American Knee Society Score, Western Ontario and McMaster Universities Osteoarthritis Index, and EuroQol 5-Dimension. Results There were no differences in the 30-day complication rates and ICU admission rate between the BTKA and UTKA groups after matching (1.4% vs. 0.9%; p = 0.60, 0.5% vs. 0.6%; p = 1.00). However, patients who underwent BTKA had a longer LOS, a higher incidence of transfusion (7.2% vs. 2.1%; p < 0.001), greater blood loss (128.6 ± 75.5 vs. 72.5 ± 45.6 mL; p < 0.001), and a more pronounced decrease in Hb levels (3.1 vs. 2.9 g/dL; p < 0.001) than those who underwent UTKA. No significant differences were observed in PROMs at one year postoperatively. Conclusions Patients who underwent BTKA reported similar 30-day complication rates, ICU admissions, and PROMs compared to UTKA. Despite higher LOS, transfusion rates, blood loss, and Hb decrease, BTKA remains a safe, effective option. It should be performed cautiously, considering patient comorbidities and overall health in treating bilateral knee OA.https://doi.org/10.1186/s13018-025-05933-7Total knee arthroplastySimultaneous surgeryKnee osteoarthritisPostoperative complicationBlood transfusionMortality |
| spellingShingle | Kwan Kyu Park Hyuck Min Kwon Byung Woo Cho Tae Sung Lee Woo-Suk Lee Jun Young Park Clinical safety and efficacy of simultaneous bilateral total knee arthroplasty in an Asian population: a propensity score-matched analysis Journal of Orthopaedic Surgery and Research Total knee arthroplasty Simultaneous surgery Knee osteoarthritis Postoperative complication Blood transfusion Mortality |
| title | Clinical safety and efficacy of simultaneous bilateral total knee arthroplasty in an Asian population: a propensity score-matched analysis |
| title_full | Clinical safety and efficacy of simultaneous bilateral total knee arthroplasty in an Asian population: a propensity score-matched analysis |
| title_fullStr | Clinical safety and efficacy of simultaneous bilateral total knee arthroplasty in an Asian population: a propensity score-matched analysis |
| title_full_unstemmed | Clinical safety and efficacy of simultaneous bilateral total knee arthroplasty in an Asian population: a propensity score-matched analysis |
| title_short | Clinical safety and efficacy of simultaneous bilateral total knee arthroplasty in an Asian population: a propensity score-matched analysis |
| title_sort | clinical safety and efficacy of simultaneous bilateral total knee arthroplasty in an asian population a propensity score matched analysis |
| topic | Total knee arthroplasty Simultaneous surgery Knee osteoarthritis Postoperative complication Blood transfusion Mortality |
| url | https://doi.org/10.1186/s13018-025-05933-7 |
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