title: Staggered bilateral total knee arthroplasty performed four to seven days apart during a single hospitalization.
abstract: 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 = 0.0001).
  
  
  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 replacement.
authors.affiliation: Department of Orthopaedics, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, USA.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Sliva
authors.forename: John J
authors.initials: JJ
authors.lastname: Callaghan
authors.forename: Devon D
authors.initials: DD
authors.lastname: Goetz
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Taylor
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000379:methods* / Q000401:mortality; D005260:Female; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies