Abstract
Background
There are several surgical options available for patients with bilateral knee osteoarthritis including simultaneous bilateral TKA (BTKA) and staged approach. The appropriate and safe time interval between two stages is still controversial. The preset systematic review aims to determine the optimal time interval between two stages of BTKA.
Methods
Pubmed database was searched from 1979 to 2013 for English-language studies that compared the outcomes of each surgical approach. Comparison was carried out on unilateral TKA and two-staged BTKA as well as on different time intervals in two-staged BTKA.
Results
Eighteen studies that enrolled patients underwent TKA either unilaterally or bilaterally in one-stage and two-stage were enrolled in this systematic review. Statistically significant difference was observed in cardiac complications (OR= 1.15, 95% CI: 1.01–1.31; P=0.03) and wound complications (OR=1.18, 95% CI: 1.07–1.3; P<0.000) following two-staged BTKA compared with unilateral TKA. There observed significant differences in favor of bilateral two-stage TKA regarding other complications including mortality (OR=0.82, 95% CI: 0.7–0.95; P<0.00), PE (OR=0.71, 95% CI: 0.64–0.78; P<0.00), knee infection (OR=0.5, 95% CI: 0.45–0.55; P<0.00) and knee revision (OR=0.42, 95% CI: 0.37–0.48; P<0.00). Increasing time interval between two stages of TKA to more than 90 days, showed a lower risk for urinary (OR=0.12, 95% CI: 0.02–0.72; P=0.02) and respiratory (OR=0.05, 95% CI: 0–0.94; P=0.04) complications.
Conclusion
The main finding of this study was that time interval of more than 90 days between two stages of BTKA may be associated with less complication rate, specially of urinary and respiratory system.
