title: Simultaneous bilateral total knee arthroplasty in severe hemophilia: a retrospective cost-effectiveness analysis.
abstract: BACKGROUND
  Simultaneous bilateral total knee arthroplasty (TKA) is proposed in the general population as an alternative to staged bilateral TKA and has the advantage of reducing costs with equivalent complication rates. The aim of this study was to evaluate the cost-effectiveness of this alternative in a population of patients with severe hemophilia.
  
  
  OBJECTIVE
  Simultaneous bilateral TKA is less expensive than staged bilateral TKA.
  
  
  METHODS
  We performed a retrospective case control study in patients with severe hemophilia A to compare the direct costs of coagulation factors, the length of hospital stay and sick leave as well as the clinical outcome (KKS) of simultaneous bilateral TKA (group 1; G1: 5 patients) and staged bilateral TKA (group 2; G2: 12 patients).
  
  
  RESULTS
  The mean cost of coagulation factors was 65,880 € in G1 and 139,000 € in G2 (P<0.001). The length of the hospital stay (24 days vs 44 cumulative days, respectively) and sick leave (105 days vs 183 cumulative days, respectively) was significantly reduced in G1. There was no significant difference in clinical outcome at the final follow-up. One patient in G2 had a late knee infection.
  
  
  CONCLUSIONS
  Simultaneous bilateral TKA in severe hemophilia is associated with lower costs than staged bilateral TKA with equivalent clinical results.
  
  
  METHODS
  Level 3, case control study.
authors: Service de chirurgie orthopédique, hôpital Ambroise-Paré, AP-HP, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France. Electronic address: andre.thes@gmail.com.
authors: A
authors: A
authors: Thès
authors: Service de chirurgie orthopédique, hôpital Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France.
authors: V
authors: V
authors: Molina
authors: Centre de référence pour le traitement de l'hémophilie, hôpital de Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France.
authors: T
authors: T
authors: Lambert
mesh_terms: D000328:Adult; D019645:Arthroplasty, Replacement, Knee / Q000191:economics* / Q000379:methods*; D003362:Cost-Benefit Analysis; D005260:Female; D006467:Hemophilia A / Q000150:complications* / Q000191:economics; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000150:complications* / Q000191:economics / Q000601:surgery; D012189:Retrospective Studies; D055815:Young Adult
keywords: Bilateral knee replacement; Cost-benefit analysis; Hemophilia A; Simultaneous total knee arthroplasty