**Author details**

*Recent Advances in Bone Tumours and Osteoarthritis*

is performed by a less experienced surgeon [37].

population [45].

**3.3 Simultaneous bilateral total knee replacement**

complication [27, 33]. Earlier publications dealing with simultaneous bilateral hip arthroplasty reported a higher rate of pulmonary embolism and a slightly higher mortality rate while performing this procedure [33–35]. Improvements in surgical technique, anaesthesiology (introduction of hypotensive anaesthesia), anticoagulant therapy and early mobilisation showed decrease in numbers of reported complications of this type. Berend and Glait [36, 37] found increased incidence rate of pulmonary thromboembolism, while majority of other authors did not mention similar findings [20, 38–41]. Some of the authors who failed to find any thromboembolic complications in their series of simultaneous procedures explain this as a better adaptation of a patient to mobilisation protocols when both hips are operated. Majority of authors reported higher need for transfusion in a simultaneous group [20, 24, 29, 32, 38, 42, 43]. Bhan found lower estimated blood loss in simultaneous group but higher number of transfusions [19]. He explained that in a staged group, blood loss is a sum of losses in two surgeries that are separated long enough for organism to compensate loss from first surgery. Some authors did not discover any increased blood loss in a simultaneous group [17, 25, 37, 44]. Glait pointed out that an increased need for transfusion can be expected if a simultaneous procedure

While history of bilateral total hip replacement is very well documented, there are almost no papers of a single-stage total knee replacement background. There is a trend of growing number of performed TKA. In the period from 1990 to 2004, number of bilateral total knee replacements doubled and even tripled in female

Similar to bilateral simultaneous hip arthroplasties, there are certain differences among authors regarding safety of the procedure, potential complications and consensus over its benefits. Overall savings from simultaneous procedure are estimated to be 20–58% with the following contributing factors: fewer hospital days, single medical consultations, single anaesthesia and single rehabilitation period [18, 46]. It is also found by majority of authors that patients in a single-stage group experience equal or better functional result and satisfaction [47, 48]. In one study, 95% of patients would rather choose a single-stage procedure all over again, demonstrating high level of satisfaction [46]. Differences among authors apply to potential increased risk of systemic and local complications, as well as to mortality rate following the procedure itself. Some register studies (the USA and Sweden) found increased morbidity and mortality rate [49, 50], while data from New Zealand arthroplasty registry show no differences between two procedures in same terms [51]. Many authors have discovered with their series of patients an increased risk in systemic complications in a single-stage group [52–55], while a few found no difference in the incidence of complications [47, 56–58]. As per selection of patients, there are only several articles recommending application of the scoring system (ASA, see above). Hadley et al. recommend performing the procedure only in ASA 1 and 2 groups [58], while several authors say this procedure is safe with ASA 1–3 groups as well [59–61]. All authors agree there is an increased blood loss in

While planning and selecting patients with bilateral osteoarthritis of big joints, it is essential to balance between medical and economic efficiency of

**134**

**4. Conclusion**

a simultaneous group [52, 58, 62].

Aleksandar Radunović1 \*, Maja Vulović2 , Milan Aksić3 , Ognjen Radunović4 and Aleksandar Matić5

1 Clinic for Orthopedic Surgery and Traumatology, Military Medical Academy, Belgrade, Serbia

2 Department of Anatomy, Faculty of Medical Sciences, University of Kragujevac, Serbia

3 Institute of Anatomy "Niko Miljanić", Serbia

4 Medical Faculty, University of Belgrade, Serbia

5 Department of Surgery, Faculty of medical sciences, Clinic for Orthopedic Surgery and Traumatology, Kragujevac, Serbia

\*Address all correspondence to: aradunovic@yahoo.com

© 2020 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
