TKR is most common and successful surgical intervention to reduce pain and improve function in patients with end stage osteoarthritis [22,23]. There are many factors should be considered before deciding surgical intervention such as patient’s age, severity, symptom duration, pre-operative medical condition, and unilateral or bilateral involvement [24]. The commonest indications for TKR include OA, traumatic arthritis and rheumatoid arthritis [24]. In the current study, all patients had a diagnosis of primary knee OA.
Average age of the patients at surgery was reported as 65 years by Waters et al. [25], 62.8 years by Heal et al. [26], 66.5 years by Barrack et al. [27], 65.2 years by Akgun et al. [28], and 64.1 years by Ekinci et al. [24]. In the current study, mean age was 61.8 and 65.7 years in bilateral TKR and unilateral TKR group, respectively.
The current study aimed to compare bilateral versus unilateral TKR on pain intensity and recovery of function at 30-days postoperatively. Results of the current study indicated that both group showed a significant pain relief and improved function after TKR at 30 days post-operatively. There was no significant difference noted between bilateral versus unilateral TKR on pain intensity and recovery of function.
Similarly, previous study reported statistically insignificant difference in pain reduction between bilateral versus unilateral TKR [29]. Another study suggested that patients underwent bilateral TKR improved function similar to those patients underwent unilateral TKR [7]. In contrast, a recent study reported that bilateral simultaneous unicompartmental knee arthroplasty shows better functional recovery at 6 month post-operatively than unilateral TKR [30]. However, a direct comparison could not be made as many methodological differences existed between previous and current study. First, previous study compared bilateral simultaneous unicompartmental knee arthroplasty with unilateral TKR; in contrast, the current study compared bilateral simultaneous TKR with unilateral TKR. Second, previous study compared outcome at 6 months postoperatively, in contrast, the current study compared outcome at one month postoperatively.
It has been recommended that patients undergo simultaneous bilateral TKR surgery had a prolong rehabilitation, increased length of hospital stay, higher blood transfusion, increased number of painful postoperative days, more number of complications, and increased financial burden [24]. Nonetheless, these parameters have been showed significantly better than in those patients undergo staged arthroplasty surgery [31–33]. Although several studies indicated that postoperative medical complications often seen in patients undergo simultaneous bilateral TKR surgery [34–36], other studies indicated similar complication rates [37,38].
In the current study, physical function was assessed using LEFS, which is a subjective self-report functional scale. An objective outcome measure could be included to assess wide range of physical function. Additionally, the current study only assessed pain and function. Other important outcome measures such as ambulation, muscle strength, mobility, range of motion, and quality of life are warranted to consider in future study.