title: Mortality and morbidity associated with simultaneous bilateral or staged bilateral total knee arthroplasty: a meta-analysis.
abstract: OBJECTIVE
  To evaluate the mortality and postoperative morbidity associated with simultaneous bilateral or staged bilateral total knee arthroplasty (TKA).
  
  
  METHODS
  We identified eligible studies in PubMed (1980-2010), OVID MEDLINE (1980-2010) and the Cochrane library. Data were extracted and evaluated by two reviewers independently. Data analyses were conducted with Stata 10.0.
  
  
  RESULTS
  Fourteen studies met our inclusion criteria. Combined results showed that the prevalence of mortality [OR = 3.202, 95% CI (1.852-5.537)], mortality at 30 days postoperatively [OR = 5.564, 95% CI (2.392-12.939)] and neurological complications [OR = 2.906, 95% CI (1.200-7.037)] were significantly higher in the population who had undergone simultaneous TKA compared with those who had undergone staged TKA. The prevalence of infection, pulmonary embolism, deep-vein thrombosis, and cardiac complications between the two populations was not significantly different.
  
  
  CONCLUSIONS
  Compared with staged bilateral TKA, simultaneous bilateral TKA might carry a higher potential risk of postoperative complications. Patients should be aware of this information when deciding whether to proceed with simultaneous bilateral TKA. The poor quality of the studies calls into question the robustness of the analyses.
authors.affiliation: Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Hu
authors.forename: Yuan
authors.initials: Y
authors.lastname: Liu
authors.forename: Zheng
authors.initials: Z
authors.lastname: Lv
authors.forename: Xiang
authors.initials: X
authors.lastname: Li
authors.forename: Xiaodong
authors.initials: X
authors.lastname: Qin
authors.forename: Weimin
authors.initials: W
authors.lastname: Fan
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012306:Risk