Different clinical outcomes on the second side after staged total knee replacement. A systematic review.


Michael-Alexander Malahias


The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. Electronic address: [Email]


BACKGROUND : The clinical outcomes of the contralateral side in staged bilateral total knee arthroplasty (BTKA) are relatively unknown. The purpose of this study was to answer: 1) Does the second-operated knee in a staged BTKA result in inferior clinical and functional outcomes? 2) Is the duration of time between the first- and the second-operated knee defined in a consistent fashion in the literature? 3) Does the time interval between TKAs influence clinical outcomes?
METHODS : Two reviewers independently conducted a systematic search of the literature using different databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
RESULTS : Five of the seven included studies reported significantly inferior postoperative clinical outcomes for the second-operated knee compared with the first-operated knee. There was no difference in the overall major complication rate between first- and second-operated TKA (2.4% and 1.2% respectively). Based on the literature reviewed, there is no consensus on the optimal time interval between the stages. Most studies, which investigated the impact of different intervals on the outcomes of the second-operated knee, concluded that the differences in outcomes with different intervals were not significant.
CONCLUSIONS : Current literature suggests that the second-operated knee, in patients undergoing staged BTKAs, might have inferior clinical outcomes when compared with the first-operated knee.


Second knee worse,Staged bilateral total joint replacement,Systematic review,Total knee arthroplasty,

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