Simultaneous Bilateral Total Knee Arthroplasty: A Technique Guide

Introduction: We present a novel technique for simultaneous bilateral total knee arthroplasty whereby 2 fellowship-trained arthroplasty surgeons operate in tandem, and an analysis of acohort of patients who underwent this procedure. Materials and Methods: A retrospective review was performed for patients who underwent simultaneous bilateral total knee arthroplasty by this technique between January 1, 2005, and March 1, 2020. Patients were eligible if they had severe bilateral knee arthritis, a body mass index <40, no significant cardiopulmonary comorbidities, and expected straightforward surgery. Descriptive statistics, independent-samples t tests, the Fisher exact test, and a χ 2 analysis were used. A P -value of ≤0.05 was considered statistically significant. Results: A total of 567 patients (1134 knees) met the inclusion criteria (age: 64.7±8.4 y, 67.4% female, 92.9% indicated for primary osteoarthritis, body mass index 33.2±7.0). The mean length of stay was 3.6±4.9 days, and the mean operative time was 72±15 minutes. 30% of the entire cohort required postoperative transfusion; however, only 1.9% after routine use of intra-articular tranexamic acid began. Forty-eight knees returned to the operating room within 1 year for any reason, of which 34 underwent manipulation under anesthesia. Although transfusion overall was associated with an increased risk of revision ( P =0.024), this was not significant when considering only patients who had surgery after the use of intraoperative tranexamic acid ( P =0.70). Ninety-day postoperative mortality was 0.4%, and postoperatively, there were 4 myocardial infarcts and 10 venous thromboembolic events. Discussion: In appropriately selected patients and optimized surgical environments, simultaneous bilateral total knee arthroplasty can be performed efficiently and safely by the described novel technique.