A Retrospective Comparative Study of the Outcomes of Single-Stage Versus Double-Stage Bilateral Total Knee Arthroplasty in the Management of Bilateral Knee Osteoarthritis

TL;DR

This study compares single-stage and double-stage knee replacement surgeries for arthritis, finding that single-stage leads to shorter hospital stays and better recovery in six months.

Contribution

The study provides new comparative evidence on hospitalization and functional outcomes between single-stage and double-stage bilateral TKA.

Findings

Single-stage TKA resulted in significantly shorter hospital stays compared to double-stage TKA.

Functional outcomes (Oxford Knee Score) were better at six months in the single-stage group.

No significant difference in perioperative complications between the two approaches.

Abstract

Background

Osteoarthritis of the knee is a prevalent chronic condition, often necessitating total knee arthroplasty (TKA) when conservative treatments fail. Single-stage and double-stage bilateral TKA procedures are both widely performed, and the optimal approach in terms of perioperative complications and functional outcomes remains debated. This study aims to compare single-stage and double-stage bilateral TKA concerning postoperative recovery, complications, and hospitalization parameters.

Methods

A retrospective study was conducted at R. L. Jalappa Hospital, Tamaka, Kolar, from August 2023 to July 2024, including 38 patients with Kellgren-Lawrence grade 3 or 4 primary osteoarthritis undergoing bilateral TKA. Patients were divided into two cohorts: Group A (n = 19) underwent single-stage TKA, and Group B (n = 19) underwent double-stage TKA (≤12 months apart). Outcomes assessed included pain (Visual Analogue Scale (VAS)), functional recovery (Oxford Knee Score (OKS), Knee Society Score (KSS)), perioperative complications, transfusion rates, and hospitalization duration. Statistical analyses compared both groups.

Results

The mean age of participants was comparable (65.74 ± 8.13 years in Group A vs. 65.58 ± 10.01 years in Group B). Both groups exhibited similar preoperative VAS (8.53 ± 1.17 vs. 8.47 ± 0.96), OKS (20.32 ± 3.20 vs. 19.74 ± 3.21), and KSS (50.58 ± 5.09 vs. 50.11 ± 5.5). The single-stage group had a significantly shorter hospital stay (6.21 ± 0.85 days vs. 7.74 ± 1.28 days, p = 0.001). Functional scores at six months showed higher OKS in Group A (50.00 ± 3.23) than Group B (47.95 ± 2.697, p = 0.040), while KSS scores were similar. Perioperative complications included deep vein thrombosis (DVT) in three (7.8%) patients, bleeding in one (2.6%) patient, pulmonary embolism (PE) in one (2.6%) patient, wound healing issues in two (5.3%) patients, and urinary complications in two (5.3%) patients, with no significant difference between groups.

Conclusion

Single-stage bilateral TKA is associated with shortened hospital stay and improved functional outcomes at six months compared to the double-stage approach, without significant differences in perioperative complications. These findings suggest that single-stage TKA may be a preferable option in carefully selected patients.