Abstract
Despite multiple studies, there remains a debate on the safety of bilateral total
knee arthroplasty (BTKA) in the average age patient, with a paucity of data on the
outcome of BTKA in an elderly population. This study included 89 patients aged 80
years and older undergoing sequential BTKA over 14 years were identified in a prospectively
collected database. Two matched comparison groups were created: patients under 80
undergoing sequential BTKA and patients over 80 undergoing unilateral TKA (UTKA).
An analysis of complications, mortality, revision, and patient-reported outcome measures
was performed. Mean age of the elderly cohorts was similar: 82.6 for BTKA and 82.9
for UTKA. The average age BTKA cohort had a mean age of 69.1. Complication rates were
higher in bilateral cohorts, more so in the elderly BTKA cohort. Pulmonary embolism
(PE) was observed in bilateral cohorts only. In these patients, history of PE and
ischemic heart disease was a strong predictive factor for developing a major complication.
There was no difference in revision rates and infection rates between the three cohorts,
and no difference in patient survivorship between the two elderly cohorts. Through
the combination of low revision and high survivorship rates and comparable clinical
outcomes, this article demonstrates that simultaneous BTKA is an appropriate option
to consider for an elderly patient, with proper patient selection and perioperative
management. The demonstrated risk groups show that emphasis on patient selection should
be focused on medical history rather than chronological age.
Keywords
knee - arthroplasty - bilateral - elderly - complications - survivorship
