Background: The purpose of this study was to evaluate the types and
prevalence of complications associated with bilateral total knee replacement
performed four to seven days apart during a single hospitalization and to
compare them with those associated with bilateral knee replacement performed
sequentially under the same anesthetic session or staged unilateral
replacements performed during separate hospitalizations.
Methods: Using a computerized database and medical records, we
retrospectively evaluated 332 consecutive patients who underwent bilateral
total knee replacement performed by two surgeons. A total of 241 patients
underwent staggered bilateral knee replacement with the procedures performed
four to seven days apart during one hospitalization, twenty-six underwent
sequential bilateral total knee replacement, and sixty-five underwent staged
bilateral knee replacement performed during two separate hospitalizations. The
data on major complications, including death, return to operating room,
myocardial infarction, and pulmonary embolism, and on minor complications,
including atrial fibrillation, deep-vein thrombosis, and urinary tract
infection, were evaluated.
Results: Patients undergoing sequential bilateral total knee
replacement and staged bilateral knee replacement had an overall rate of
complications that was 2.5 times higher than that of the staggered group.
Major complications were rare in all groups, but they occurred most often in
the staged bilateral replacement group. The overall rate of complications for
the patients who had staggered bilateral knee replacement (13%) was
significantly less (p = 0.0009) than that for the patients who had sequential
bilateral knee replacement (35%) or staged bilateral knee replacement (31%).
The length of inpatient stay for those with staggered total knee arthroplasty
was four days longer than that for the sequential arthroplasty group (p =
Conclusions: Staggered bilateral total knee replacement, with the
procedures performed four to seven days apart in a single hospitalization, is
a safe and practical method for performing bilateral total knee
Level of Evidence: Therapeutic Level III. See
Instructions to Authors for a complete description of levels of evidence.