Simultaneous Bilateral Total Knee Arthroplasty: What Is the Value? Commentary on an article by Susan M. Odum, PhD, and Bryan D. Springer, MD: "In-Hospital Complication Rates and Associated Factors After Simultaneous Bilateral Versus Unilateral Total Knee Arthroplasty".

Abstract

Total knee arthroplasty has long been shown to be both safe and efficacious for the treatment of degenerative conditions of the knee—relieving pain, restoring function, correcting deformity, and providing measurable improvements in quality of life. Total knee arthroplasty also has been demonstrated to be very cost-effective from a societal perspective, with estimates between ten and twenty thousand dollars per quality-adjusted life year (QALY)1. Frequently, patients present with bilateral symptomatic disease and deformity, prompting patients and surgeons to consider simultaneous bilateral total knee arthroplasty. The number of total knee arthroplasties performed and rate of utilization in the United States has grown exponentially over the last several decades. In fact, more than 700,000 were performed in 2010, with projections of more than three million total knee arthroplasties expected to be performed annually by 20302. The surgical demand creates major financial strains on the American health-care system and, in part, is responsible for the pay-for-performance measures enacted by the Centers for Medicare & Medicaid Services (CMS) and the recent public reporting of outcomes for total hip and total knee arthroplasty surgery. Simultaneous bilateral total knee arthroplasty has represented a consistent 4% to 6% of total knee arthroplasties performed annually in the United States1,3,4. Despite a lengthy history of surgeons performing simultaneous bilateral total knee arthroplasty, there continues to be debate about the indications for the procedure and concern regarding its overall safety. Those surgeons who support the use of simultaneous bilateral total knee arthroplasty cite decreased cost, improved recovery time, the utilization of a single anesthetic, and equal functional outcomes when compared with staged bilateral total knee arthroplasty. Those surgeons who favor staged bilateral total knee arthroplasty cite increased mortality, both in-hospital and within thirty days …