Purpose of the study: This work was a retrospective review of bilateral total knee arthroplasties implanted by one operator during simultaneous or successive procedures. The purpose of the present study was to compare blood loss, operative time, iatrogenic effects, duration of management, and functional outcome in the two cohorts.

Material and methods: The study included 111 patients who underwent bilateral total knee arthroplasty (74 simultaneous implantations and 37 successive implantations). The procedures had been performed between January 1994 and December 2004. Management practices, and in particular transfusion practices, were the same. Care for postoperative pain (use of patient-controlled peridural injections) and rehabilitation practices were also similar for the two cohorts.

Results: There was not significant difference in postoperative complications between the two cohorts. Functional outcome was also the same. The duration of management was shorter for simultaneous operations. This was particularly noteworthy for older patients.

Discussion: Data in the literature is somewhat discordant concerning the use of simultaneous or successive procedures. There is an abundance source of data in the English literature but few reports from France. In our situation, we have used the analysis proposed by Hungerford concerning the outcome of the contralateral knee after insertion of one total knee arthroplasty. If the contralateral knee presents severe clinical signs and average radiographic anomalies or on the contrary average clinical signs and severe radiographic anomalies, we propose a simultaneous bilateral implantation. Pre- and postoperative care is particularly important for success.

Conclusion: Based on our experience, the benefit-risk-cost relationship favors simultaneous implantation of bilateral total knee arthroplasties in patients with advanced-stage bilateral degenerative joint disease.