Total knee arthroplasty (TKA) may be performed as a unilateral procedure or as a bilateral intervention, either simultaneously or in a staged manner. Although simultaneous bilateral TKA may reduce cumulative hospitalization, concerns remain regarding increased perioperative blood loss and transfusion burden. Comparative interpretation of these strategies is further complicated by real-world differences in patient selection and perioperative practice patterns. This retrospective cohort study included patients who underwent primary unilateral, simultaneous bilateral, or staged bilateral TKA at a tertiary referral center between December 2014 and July 2024. All procedures were performed by a single surgeon. Perioperative erythrocyte suspension (ES) transfusion requirement and length of hospital stay were evaluated. Analyses were descriptive and comparative, without causal inference. A total of 219 patients were included, comprising 108 unilateral, 95 simultaneous bilateral, and 16 staged bilateral TKA cases. Perioperative ES transfusion rates differed significantly among the three surgical strategies, with the highest proportion of transfused patients observed in the simultaneous bilateral TKA group, followed by the staged bilateral and unilateral groups. Length of hospital stay also differed significantly among the groups, with the shortest hospitalization observed after simultaneous bilateral TKA and the longest after unilateral TKA. In this real-world retrospective cohort, simultaneous bilateral TKA was associated with a higher in-hospital transfusion burden, whereas unilateral TKA was associated with a longer hospital stay. These differences appear to reflect not only operative extent but also patient selection and institutional perioperative practice patterns. Accordingly, the findings should be interpreted as descriptive rather than as evidence of definitive superiority of one surgical strategy over another.
Gunay et al. (Fri,) studied this question.