title: Simultaneous bilateral total knee arthroplasty in patients with haemophilia: a safe and cost-effective procedure?
abstract: BACKGROUND
  Haemophilic arthropathy of the knee is usually a bilateral affliction. The patients usually refer for treatment in young ages and do not have major comorbidities, being fit for bilateral simultaneous total knee arthroplasty.
  
  
  OBJECTIVE
  In this study, we assessed the safety and cost-effectiveness of simultaneous bilateral surgery in patients with haemophilia.
  
  
  METHODS
  Between April 2010 and April 2012, eight patients (16 knees) underwent bilateral simultaneous and 19 patients (19 knees) underwent unilateral total knee arthroplasty (TKA) at our institution. We compared the range of motion and flexion contracture, KSS, WOMAC knee score and SF36 quality of life score between two groups. The duration of hospital stay, coagulation factor consumption and all inpatient costs were recorded. The average follow-up was 26 and 29 months in unilateral and bilateral groups respectively.
  
  
  RESULTS
  At the conclusion of the study, the KSS and WOMAC and SF36 scores were not significantly different between the two groups. Mean ROM and flexion contracture did not differ significantly. The mean length of hospital stay was 15 days for bilateral patients and 12 days for unilateral patients, the difference being non-significant. None of our patients needed transfusion in any group. The cost of simultaneous bilateral TKA was about half of the expenses of staged bilateral TKA.
  
  
  CONCLUSIONS
  Simultaneous bilateral TKA seems to be a safe and cost-effective approach without increasing the rate of complications in patients' bilateral haemophilic knee arthropathy. The procedure is, at least, as effective as staged unilateral knee arthroplasty in improving the patients' quality of life.
authors.affiliation: Investigation was performed in Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: S M J
authors.identifier: http://orcid.org/0000-0003-4189-7777
authors.initials: SMJ
authors.lastname: Mortazavi
authors.affiliation: Investigation was performed in Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: B
authors.identifier: http://orcid.org/0000-0003-4982-5364
authors.initials: B
authors.lastname: Haghpanah
authors.affiliation: Investigation was performed in Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: M M
authors.initials: MM
authors.lastname: Ebrahiminasab
authors.affiliation: Investigation was performed in Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: T
authors.initials: T
authors.lastname: Baghdadi
authors.affiliation: Ministry of Health and Medical Education, Office of Organ Transplantation and Special Diseases, Tehran, Iran.
authors.forename: R
authors.initials: R
authors.lastname: Hantooshzadeh
authors.affiliation: Tehran University of Medical Sciences, Thrombosis Hemostasis Research Center, Tehran, Iran.
authors.forename: G
authors.initials: G
authors.lastname: Toogeh