Introduction: The use of simultaneous bilateral knee replacement surgery remains controversial–several studies have reported increased rates of complications, and the use of the technique remains in question. However, many of these procedures are not truly simultaneous, meaning it is difficult to draw accurate conclusions on the safety of this technique from the published literature.

Method: A retrospective notes based review of all those patients undergoing bilateral knee replacement surgery between 2000 and 2005 at Harrogate District Hospital was performed. Patients undergoing both unicompartmental (UNI) and total knee replacement (TKR) were included. Procedures were performed by a consultant orthopaedic surgeon and his knee fellow with one scrub team. The post operative morbidity and mortality was assessed both 30 days post operatively and also at six month follow up.

Results: A total of 112 procedures were performed over the five year period. There were no deaths reported within the study group. Within the group there were 3 DVT’s, 2 superficial wound infections and one case of aseptic loosening at six months. Average tourniquet time was 76 minutes for the TKR group and 82 minutes for the UNI group. Average length of stay over the five year period was 8.6 nights (TKR) and 6.6 nights (UNI).

Conclusion: Bilateral truly simultaneous knee replacement surgery is a safe technique with favourable rates of complications. It offers the benefit of improved efficiency with regard to both theatre time and length of hospital stay, which is valuable in the modern climate of economic strain within health services worldwide. It also offers an excellent opportunity to the trainee to operate independently within a controlled environment, and is favoured by patients–offering a single admission and rehabilitation period.

Aim: To assess the safety and efficiency of bilateral simultaneous total knee replacement surgery using a retrospective notes based review.

Methods: We performed a retrospective case note review of a series of 112 bilateral simultaneous knee replacements performed over a five year period in a district general hospital. (224 joints – 142 total joints, 82 unicompartmental). The procedures were all performed by a consultant knee surgeon operating alongside a knee fellow. Patients were only offered bilateral procedures if in ASA class I/II. (any borderline candidates were referred for anaesthetic assessment). Results were obtained for a number of parameters to assess the safety of this technique by measuring rates of both minor and major complications. Data was also gathered to assess the efficiency of the technique – measuring both tourniquet times and length of stay.

Results: Over the period of five years there were no deaths or major complications reported. There were three cases of DVT (2.6%) and one case of PE (0.9%). There were three cases of superficial wound infection (2.6%), one of joint infection (0.9%) and one of aseptic loosening (0.9%). Average tourniquet time was 76 minutes with an average length of stay of 8.6 nights.

Conclusion: Bilateral simultaneous knee replacement is a valuable technique which offers the patient a single operation and recovery period, and return to normal life. In addition, the complication rates are acceptable, unlike several studies looking at bilateral procedures performed back to back. It also offers an excellent training opportunity for the 2^nd surgeon to operate under close supervision. In an increasingly time pressured health service we believe this procedure is an efficient and safe technique when used in suitable patients.