Park Kwan Kyu, Kwon Hyuck Min, Cho Byung Woo, Lee Tae Sung, Lee Woo-Suk, Park Jun Young
Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
J Orthop Surg Res. 2025 May 24;20(1):508. doi: 10.1186/s13018-025-05933-7.
Clear clinical guidelines on performing simultaneous bilateral total knee arthroplasty (BTKA) are lacking. We compare the clinical outcomes between BTKA and unilateral total knee arthroplasty (UTKA) using propensity score matching to assess safety and clinical efficacy, hypothesizing no difference in clinical safety.
Among 1,665 BTKA and UTKA cases, patients were matched in a 1:1 ratio by age, sex, body mass index, follow-up, and comorbidities, resulting in 653 patients per group. Primary outcomes included 30-day complication rates and intensive care unit (ICU) admission rates. Secondary outcomes included length of stay (LOS), transfusion rate, estimated blood loss, hemoglobin (Hb) levels (preoperative and two days postoperative), Hb decrease, and 1-year mortality rate. The patient-reported outcomes (PROMs) was measured preoperatively and at 3, 6, and 12 months postoperatively using the American Knee Society Score, Western Ontario and McMaster Universities Osteoarthritis Index, and EuroQol 5-Dimension.
There were no differences in the 30-day complication rates and ICU admission rate between the BTKA and UTKA groups after matching (1.4% vs. 0.9%; p = 0.60, 0.5% vs. 0.6%; p = 1.00). However, patients who underwent BTKA had a longer LOS, a higher incidence of transfusion (7.2% vs. 2.1%; p < 0.001), greater blood loss (128.6 ± 75.5 vs. 72.5 ± 45.6 mL; p < 0.001), and a more pronounced decrease in Hb levels (3.1 vs. 2.9 g/dL; p < 0.001) than those who underwent UTKA. No significant differences were observed in PROMs at one year postoperatively.
Patients who underwent BTKA reported similar 30-day complication rates, ICU admissions, and PROMs compared to UTKA. Despite higher LOS, transfusion rates, blood loss, and Hb decrease, BTKA remains a safe, effective option. It should be performed cautiously, considering patient comorbidities and overall health in treating bilateral knee OA.
目前缺乏关于同期双侧全膝关节置换术（BTKA）的明确临床指南。我们使用倾向评分匹配法比较BTKA与单侧全膝关节置换术（UTKA）的临床结果，以评估安全性和临床疗效，假设临床安全性无差异。
在1665例BTKA和UTKA病例中，根据年龄、性别、体重指数、随访情况和合并症以1:1的比例对患者进行匹配，每组各653例。主要结局包括30天并发症发生率和重症监护病房（ICU）入住率。次要结局包括住院时间（LOS）、输血率、估计失血量、血红蛋白（Hb）水平（术前和术后两天）、Hb下降幅度以及1年死亡率。术前以及术后3、6和12个月使用美国膝关节协会评分、西安大略和麦克马斯特大学骨关节炎指数以及欧洲五维健康量表对患者报告结局（PROMs）进行测量。
匹配后，BTKA组和UTKA组的30天并发症发生率和ICU入住率无差异（1.4%对0.9%；p = 0.60，0.5%对0.6%；p = 1.00）。然而，与接受UTKA的患者相比，接受BTKA的患者住院时间更长，输血发生率更高（7.2%对2.1%；p < 0.001），失血量更大（128.6±75.5对72.5±45.6 mL；p < 0.001），Hb水平下降更明显（3.1对2.9 g/dL；p < 0.001）。术后一年的PROMs未观察到显著差异。
与UTKA相比，接受BTKA的患者报告的30天并发症发生率、ICU入住率和PROMs相似。尽管住院时间更长，但BTKA输血率更高、失血量更大、Hb下降幅度更大，但它仍然是一种安全有效的选择。在治疗双侧膝关节骨关节炎时，应谨慎考虑患者的合并症和整体健康状况后进行手术。
