title: Perioperative safety of two-team simultaneous bilateral total knee arthroplasty in the obese patient.
abstract: BACKGROUND
  Although the rates of perioperative morbidity and mortality with simultaneous bilateral total knee arthroplasty remain a concern, multiple studies have shown the procedure to be safe in selected patient populations. Evidence also remains mixed regarding the outcomes of total knee arthroplasty in obese patients. The purpose of this paper is to compare the rates of perioperative morbidity and mortality in consecutive obese patients undergoing two-team simultaneous bilateral total knee arthroplasty and unilateral total knee arthroplasty.
  
  
  METHODS
  The records on all two-team simultaneous total knee arthroplasties and unilateral total knee arthroplasties from October 1997 to December 2007 were reviewed. A total of 151 patients with a body mass index (BMI) >30 undergoing two-team simultaneous total knee arthroplasty and 148 patients with a BMI >30 undergoing unilateral total knee arthroplasty were retrospectively reviewed and analyzed to determine perioperative morbidity and mortality as well as one-year mortality rates.
  
  
  RESULTS
  Preoperative patient characteristics did not show any significant differences between groups. The simultaneous bilateral group had significantly longer operative times (127.4 versus 112.7 minutes, p < 0.01), estimated blood loss (176.7 versus 111.6 mL, p = 0.01), percentage of patients requiring blood transfusion (64.9% versus 13.9%, p < 0.01), length of hospital stay (3.72 versus 3.30 days, p < 0.01), and percentage of patients requiring extended care facility usage at discharge (63.6% versus 27.8%, p < 0.01). No significant difference between unilateral and bilateral groups was seen in regards to total complication rate, major or minor complication subgroup rate, or any particular complication noted. Doubling the variables in the unilateral group for a staged total knee arthroplasty scenario did create significant increases over the simultaneous data in almost every data category.
  
  
  CONCLUSIONS
  Two-team simultaneous total knee arthroplasty appears to be safe in obese patients, with similar complication rates as compared to unilateral procedures. Two-team simultaneous total knee arthroplasty also appears to have potential benefits over a staged procedure in the obese patient, although more study is required regarding this topic.
authors.affiliation: Department of Orthopaedic Surgery, Mount Carmel Medical Center, MSB 3rd Floor, 793 W, State Street, Columbus, Ohio, 43222, USA. drbentaylor@gmail.com.
authors.forename: Benjamin C
authors.initials: BC
authors.lastname: Taylor
authors.forename: Craig
authors.initials: C
authors.lastname: Dimitris
authors.forename: John G
authors.initials: JG
authors.lastname: Mowbray
authors.forename: Steven T
authors.initials: ST
authors.lastname: Gaines
authors.forename: Robert N
authors.initials: RN
authors.lastname: Steensen