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Joint Replacement

A Great Look at the Risk of Same-day Bilateral TKA

A lovely study gives some compelling evidence to stage your TKAs

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Smart Practice: Avoid doing same-day bilateral TKAs unless there is a genuinely compelling reason to perform both at once.

What’s the Claim?

A well-matched, large-database study from a nationally representative all-payer source found that, compared to unilateral TKAs, patients undergoing same-day bilateral TKA had more than double the odds of:

  • Pulmonary embolism
  • Stroke
  • Blood transfusion (the odds ratio for this almost-entirely preventable complication was nearly 8)

How’s It Stack Up?

Arthroplasty surgeons have been arguing about this one for a very long time, and, honestly, the persistence of this argument makes little sense to me. Most of the large, well-done studies (of which the current study is a great example) have convincingly pointed out the increased risks of same-day bilateral TKA. By contrast, the most-irresponsible claims favoring B TKA come from small, local studies that are too small to discern differences in uncommon — but nonetheless serious or life-threatening — complications. And systematic reviews of such soft stuff are nothing more than case studies in “garbage in, garbage out.”

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