Staged bilateral total knee arthroplasty is performed increasingly frequently but no data has been published comparing the specific outcome for the first knee replacement to that of the second. Pre-operative and post-operative Oxford Knee Scores (/ 48) were reviewed for each knee in a series of 91 patients undergoing staged bilateral total knee arthroplasty over a 5-year period. Pre-operative scores for the first total knee arthroplasty were significantly worse with a mean of 14.9 in comparison to 17.0 for the second knee (P=0.0083). While there was no significant difference between the mean post-operative scores for the first knee (37.4) and the second knee (36.6) (P=0.195), the mean improvement was significantly less for the second knee (22.6 points versus 19.6 points) (P=0.0045). Our results demonstrate that in patients undergoing staged