Bilateral Versus Unilateral Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of Safety and Functional Outcomes.
Hussayn Shinwari, Hanan T Shinwari, Zakariya Mouyer et al.
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In 30 seconds
This systematic review and random-effects meta-analysis compared safety and functional outcomes after simultaneous bilateral total knee arthroplasty (SBTKA) versus unilateral TKA (UTKA), drawing on 52 studies and 5,859,125 patients. SBTKA was associated with higher complication rates (RR 1.42; 95% CI: 1.21 to 1.67; P < 0.001) and a longer hospital stay (mean 0.8 days; 95% CI: 0.3 to 1.3; P = 0.003). Mortality and readmission were similar between groups, as were most reported functional and quality-of-life outcomes; 2-year Knee Society Scores may favor SBTKA.
Key findings
- Complication rates were higher after SBTKA than UTKA (RR 1.42; 95% CI: 1.21 to 1.67; P < 0.001).
- SBTKA was associated with a longer length of stay (mean 0.8 days; 95% CI: 0.3 to 1.3; P = 0.003).
- Mortality (RR 1.12; 95% CI: 0.79 to 1.59; P = 0.55) and readmission (RR 1.13; 95% CI: 0.91 to 1.41; P = 0.29) were similar.
- Range of motion, most functional scores, and health-related quality of life were broadly comparable; 2-year Knee Society Scores may favor SBTKA.
Why it matters
The findings clarify the trade-off reported across a large evidence base: bilateral surgery is associated with more complications and a longer stay, while measured functional and quality-of-life outcomes are generally comparable. These results can inform discussions of procedural options, but the review does not establish which approach is preferable for an individual patient.
What to keep in mind
The review calls for further high-quality studies to clarify long-term outcomes and guide patient selection; the abstract does not provide detail on the quality or heterogeneity of the included studies.