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Bilateral Knee Replacement

- Discussion:
     - multiple reviews have demonstrated that simultaneous vs. staged knee total knee arthroplasty offers similar results with lower overall costs.
     - prominent studies include Morrey, et al (1987) (N=1253), Ranawat, et al (1994) (N=155), Ritter (1987) (N=264), Brotherton, et al (1986)(N=94), and McLaughlin and Fisher (1985) (N=136).
     - above studies all demonstrated that overall complications were all equal between simultaneous and staged groups except McLaughlin and Fisher that demonstrated lower complications in the simultaneous bilateral TKA group. 
     - the rate of infection and pulmonary embolism was equal in both groups of all studies mentioned. 
     - blood loss and transfusion requirements were approximately equal in Ritter’s and Brotherton, et al’s studies.
     - Ranawat’s study demonstrated increased drain output in the simultaneous group (1500 cc) vs. the staged group (1000 cc) and higher homologous blood requirements in the simultaneous group (60%) vs. the staged group (30%). 
     - all studies demonstrated that costs and overall hospital stays were significantly less with the simultaneous group.
     - Morrey’s 1987 study demonstrated that mortality and loosening rates were equal.
     - Ranawat’s 1994 study demonstrated that mortality was equal between the two groups and medical risk is not a factor.
            - the aforementioned data suggests that simultaneous bilateral TKA is a cost-effective strategy for willing patients who understand that  rehabilitation will be more demanding and painful initially.
            - these procedures should probably be reserved for centers where a large volume of total knee arthroplasty is performed.
            - additionally, patients with substantial deformity, where persistent unilateral deformity would delay the rehabilitation of the corrected extremity, are the most likely to gain from simultaneous procedures. 

- references: 

- Impact of modern technique on long-term results of total condylar knee arthroplasty
- Bilateral simultaneous total knee arthroplasty
- Staged versus simultaneous bilateral total knee replacement
- Bilateral total knee arthroplasties. Comparison of simultaneous (two team), sequential, and staged knee replacements
- Successive bilateral total knee replacement.
- Complications and mortality associated with bilateral or unilateral total knee arthroplasty.
- Intraoperative monitoring for safety of bilateral total knee replacement.
- Simultaneous bilateral total knee arthroplasties: who decides?
- Is obesity a contraindication to bilateral total knee arthroplasties under one anesthetic?
- Unilateral vs Bilateral Total Knee Arthroplasty: Risk Factors Increasing Morbidity
- A Population-Based Comparison of the Incidence of Adverse Outcomes After Simultaneous-Bilateral and Staged-Bilateral Total Knee Arthroplasty
- Steroid Modulation of Cytokine Release and Desmosine Levels in Bilateral Total Knee Replacement: A Prospective, Double-Blind, Randomized Controlled Trial