Legal Perspective on Simultaneous Bilateral Total Knee Replacement: A Review of Related Court Case Verdicts in India

Simultaneous bilateral total knee replacement (SBTKR) is increasingly used to manage advanced bilateral knee osteoarthritis, particularly in India, where the disease affects approximately 22–39% of the population. Although SBTKR offers advantages such as single anesthesia, reduced hospital stay, and lower overall costs, it is accompanied by significant clinical and medicolegal concerns, particularly in high-risk populations. This review explores the clinical outcomes and litigation landscape of SBTKR in India, analyzes landmark legal cases, and proposes strategies to enhance both surgical safety and medicolegal accountability. A narrative review was conducted using the literature from PubMed, Scopus, and Indian legal databases. Clinical data were synthesized from studies published between 2000 and 2025. Legal precedents were drawn from consumer forum judgments and higher court rulings relevant to orthopedic malpractice and informed consent issues. Contemporary evidence indicates that SBTKR is as safe as staged procedures in well-selected patients. However, perioperative complications, such as infections, thromboembolic events, and unanticipated systemic deterioration, continue to trigger litigation. Legal case analysis revealed that lapses in preoperative evaluation, absence of cardiology clearance, and inadequate or undocumented consent were pivotal in determining the judicial outcomes. Conversely, detailed documentation and adherence to guidelines significantly strengthened the defense positions. Optimizing patient selection, enforcing thorough informed consent, maintaining comprehensive records, and integrating multidisciplinary preoperative assessments are crucial for enhancing both clinical and legal outcomes of SBTKR. Establishing robust institutional protocols and medicolegal training can mitigate the risk of litigation in orthopedic practice.