Skip Navigation U.S. Department of Health and Human Services www.hhs.gov
Agency for Healthcare Research Quality www.ahrq.gov
Archive print banner

Clinical Decisionmaking

This information is for reference purposes only. It was current when produced and may now be outdated. Archive material is no longer maintained, and some links may not work. Persons with disabilities having difficulty accessing this information should contact us at: https://info.ahrq.gov. Let us know the nature of the problem, the Web address of what you want, and your contact information.

Please go to www.ahrq.gov for current information.

Patients and doctors need to weigh the risks and benefits of simultaneous versus staged bilateral knee replacement

Arthritis of the knee is common, particularly among the elderly. Total knee replacement (TKR) surgery is frequently used to alleviate pain and improve function in patients with severe knee arthritis. For patients with problems in both knees, there are advantages to having both knees replaced in a single procedure (simultaneous bilateral TKR), according to a study by the Total Knee Replacement Patient Outcomes Research Team (PORT), which was supported by the Agency for Healthcare Research and Quality (HS06432).

The researchers found that patients who underwent simultaneous bilateral TKR had about 20 percent lower risk of reoperation than those who underwent staged bilateral TKR (both knees replaced in two staged procedures). Nevertheless, the reoperation rates were low for both groups, less than 1 percent at 2 years.

Cumulative mortality rates were about 0.5 percent higher for the simultaneous versus staged surgery group at 1 month (0.99 percent versus 0.38 percent) and 6 months (1.93 percent versus 1.39 percent). This difference was reduced by half at 1 year, and the rates were nearly the same by 2 years. Other studies have shown that the simultaneous approach has a lower complication rate (for example, postoperative wound infection or hemorrhage), lower total cost, and shorter hospital stay compared with staged bilateral TKR.

The researchers point out that patients and their doctors need to balance the risks and benefits of simultaneous bilateral TKR versus staged bilateral TKR when making the knee replacement decision. The PORT was led by Deborah A. Freund, Ph.D., M.P.H., formerly of Indiana University and now with Syracuse University. The researchers retrospectively analyzed 1985 to 1990 Medicare data on 11,771 Medicare enrollees who underwent bilateral simultaneous or staged TKR between 1985 and 1988.

More details are in "Revision rates following staged and simultaneous bilateral knee replacement," by Barry P. Katz, Ph.D., Ziao-Hua Zhou, Ph.D., Sujuan Gao, Ph.D., and others in the September 1999 Journal of Clinical Outcomes Management 6(8), pp. 30-34.

Return to Contents
Proceed to Next Article

The information on this page is archived and provided for reference purposes only.

 

AHRQ Advancing Excellence in Health Care