{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:42:27Z","timestamp":1787755347442,"version":"build-2784847793"},"reference-count":37,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"14","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,7,19]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Total knee arthroplasty (TKA) is a highly successful surgical procedure that decreases pain and improves function. Many patients who undergo TKA may require surgical intervention on both extremities because of bilateral osteoarthritis. The purpose of this study was to evaluate the safety of simultaneous bilateral TKA compared with that of unilateral TKA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Patients who underwent unilateral or simultaneous bilateral primary, elective TKA from 2015 to 2020 were identified using the Premier Healthcare Database. Subsequently, the simultaneous bilateral TKA cohort was matched to the unilateral TKA cohort in a 1:6 ratio by age, sex, race, and presence of pertinent comorbidities. Patient characteristics, hospital factors, and comorbidities were compared between the cohorts. The 90-day risks of postoperative complications, readmission, and in-hospital death were assessed. Differences were assessed using univariable regression, and multivariable regression analyses were performed to account for potential confounders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Overall, 21,044 patients who underwent simultaneous bilateral TKA and 126,264 matched patients who underwent unilateral TKA were included. After accounting for confounding factors, patients who underwent simultaneous bilateral TKA demonstrated a significantly increased risk of postoperative complications, including pulmonary embolism (adjusted odds ratio [OR], 2.13 [95% confidence interval (CI), 1.57 to 2.89]; p &lt; 0.001), stroke (adjusted OR, 2.21 [95% CI, 1.42 to 3.42]; p &lt; 0.001), acute blood loss anemia (adjusted OR, 2.06 [95% CI, 1.99 to 2.13]; p &lt; 0.001), and transfusion (adjusted OR, 7.84 [95% CI, 7.16 to 8.59]; p &lt; 0.001). Patients who underwent simultaneous bilateral TKA were at increased risk of 90-day readmission (adjusted OR, 1.35 [95% CI, 1.24 to 1.48]; p &lt; 0.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Simultaneous bilateral TKA was associated with increased rates of complications including pulmonary embolism, stroke, and transfusion. Orthopaedic surgeons and patients should consider these potential complications when contemplating simultaneous bilateral TKA. When simultaneous bilateral TKA is pursued, patient counseling and thorough medical optimization should be performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Therapeutic\n                      <jats:underline>Level III<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.23.00112","type":"journal-article","created":{"date-parts":[[2023,7,7]],"date-time":"2023-07-07T15:54:11Z","timestamp":1688745251000},"page":"1072-1079","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":35,"title":["Complications and Safety of Simultaneous Bilateral Total Knee Arthroplasty"],"prefix":"10.2106","volume":"105","author":[{"given":"Mary K.","family":"Richardson","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3691-6064","authenticated-orcid":false,"given":"Kevin C.","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cory K.","family":"Mayfield","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie M.","family":"Kistler","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0447-5762","authenticated-orcid":false,"given":"Alexander B.","family":"Christ","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1293-1702","authenticated-orcid":false,"given":"Nathanael D.","family":"Heckmann","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2023,7,7]]},"reference":[{"issue":"12","key":"bib1-20250430","doi-asserted-by":"crossref","first-page":"1113","DOI":"10.1001\/archinternmed.2009.136","article-title":"Cost-effectiveness of total knee arthroplasty in the United States: patient risk and hospital volume","volume":"169","author":"Losina","year":"2009","journal-title":"Arch Intern Med."},{"issue":"11","key":"bib2-20250430","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1056\/NEJM199009133231106","article-title":"Total hip and total knee replacement (1)","volume":"323","author":"Harris","year":"1990","journal-title":"N Engl J Med."},{"issue":"17","key":"bib3-20250430","doi-asserted-by":"crossref","first-page":"1455","DOI":"10.2106\/JBJS.17.01617","article-title":"Projected volume of primary total joint arthroplasty in the U.S., 2014 to 2030","volume":"100","author":"Sloan","year":"2018","journal-title":"J Bone Joint Surg Am."},{"issue":"3","key":"bib4-20250430","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1002\/acr.21825","article-title":"Perception and presentation of function in patients with unilateral versus bilateral knee osteoarthritis","volume":"65","author":"Marmon","year":"2013","journal-title":"Arthritis Care Res (Hoboken)."},{"issue":"4","key":"bib5-20250430","doi-asserted-by":"crossref","first-page":"303","DOI":"10.2106\/JBJS.20.01046","article-title":"Bilateral simultaneous total knee arthroplasty may not be safe even in the healthiest patients","volume":"103","author":"Warren","year":"2021","journal-title":"J Bone Joint Surg Am."},{"issue":"8","key":"bib6-20250430","first-page":"780","article-title":"Morbidity and mortality of simultaneous bilateral total knee arthroplasty","volume":"31","author":"Patil","year":"2008","journal-title":"Orthopedics."},{"issue":"10","key":"bib7-20250430","doi-asserted-by":"crossref","first-page":"1981","DOI":"10.2106\/00004623-200310000-00018","article-title":"Comparison of simultaneous bilateral with unilateral total knee arthroplasty in terms of perioperative complications","volume":"85","author":"Bullock","year":"2003","journal-title":"J Bone Joint Surg Am."},{"issue":"13","key":"bib8-20250430","doi-asserted-by":"crossref","first-page":"1058","DOI":"10.2106\/JBJS.M.00065","article-title":"In-hospital complication rates and associated factors after simultaneous bilateral versus unilateral total knee arthroplasty","volume":"96","author":"Odum","year":"2014","journal-title":"J Bone Joint Surg Am."},{"issue":"6","key":"bib9-20250430","doi-asserted-by":"crossref","first-page":"1220","DOI":"10.2106\/00004623-200706000-00009","article-title":"Safety of simultaneous bilateral total knee arthroplasty. 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