Abstract
Introduction: Debate continues regarding the optimal timing of surgery for patients requiring bilateral knee arthroplasty; we reviewed the costs, clinical and functional outcomes of 116 patients undergoing simultaneous or staged bilateral surgery using 3 different prostheses.
Method: Data were retrospectively collected from 116 consecutive patients undergoing 232 knee replacements over 10 years, either simultaneously or over 2 hospital admissions (staged). Post-operative complication rate, total cost of treatment (calculated from pros-theses, theatre time, days in hospital and number of clinic attendances) and functional (HSS) score at 1 year were the outcome measures.
Results: 54 patients underwent Oxford unicondylar knee replacements, 41 simultaneously, 13 staged; respective mean total costs were £9890 and £13,553 (p< 0.001). 42 patients were treated with AGC prostheses; 14 simultaneously, 28 staged, with respective total costs of £12,187 and £16,920 (p< 0.001). 10 TMK patients had simultaneous surgery (mean total cost £14,812), 10 were staged (£20,191); p< 0.001. For all 3 prostheses, there was no significant difference in complication rate or 1 year functional outcome between simultaneous and staged groups.
Discussion: Some authors advocate replacing both knees simultaneously as safe and cost-effective; others report significant increases in medical and surgical morbidity. Our series shows significant cost savings with no increase in complication rate.
Correspondence should be addressed to Mr Tim Wilton, BASK at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE.
