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Purpose: In patients with moderate-to-severe bilateral medial knee osteoarthritis, it is difficult to determine the necessity of the subsequent contralateral total knee arthroplasty (TKA) after performing the first procedure. This study aimed to compare patient characteristics and clinical outcomes between patients who underwent staged bilateral TKA (group B) and those who underwent unilateral TKA (group U) to identify predictors of contralateral TKA requirement. Methods: Among 153 patients with bilateral medial knee osteoarthritis of Kellgren-Lawrence grade 3 or 4, 43 and 110 patients underwent unilateral and bilateral TKA, respectively. Clinical evaluations using the patient-reported outcome measure (the Japanese Knee Osteoarthritis Measure [JKOM]), the Knee Society Score (KSS), and the timed “Up and Go” test (TUG) were performed preoperatively, at 12 months, and once every year up to 5 years after the unilateral and the contralateral TKA in groups U and B, respectively. Receiver Operating Characteristic (ROC) analysis was used to determine the cut-off value for preoperative JKOM score that indicates the contralateral TKA. Results: There were no significant differences in patient characteristics between groups B and U. The preoperative JKOM scores were significantly worse in group B. Postoperative improvements in JKOM, KSS, and TUG were statistically significant in both groups; however, there were no significant differences in post-procedure scores between the two groups. ROC analysis showed that the optimal cut-off value of the preoperative JKOM score was 41.5 points. Conclusion: A preoperative JKOM score of ≥41.5 is a possible predictor of the contralateral TKA in patients with moderate-to-severe bilateral medial knee osteoarthritis.

Aims: Up to one in five patients undergoing primary total hip (THA) and knee arthroplasty (TKA) require contralateral surgery. This is frequently performed as a staged procedure. This study aimed to determine if outcomes, as determined by the Oxford Hip Score (OHS) and Knee Score (OKS) differed following second-side surgery. Methods: Over a five-year period all patients who underwent staged bilateral primary THA or TKA utilizing the same type of implants were studied. Eligible patients had both preoperative and one year Oxford scores and had their second procedure completed within a mean (2 SDs) of the primary surgery. Patient demographics, radiographs, and OHS and OKS were analyzed. Results: A total of 236 patients met the inclusion criteria, of which 122 were THAs and 114 TKAs. The mean age was 66.5 years (SD 9.4), with a 2:1 female:male ratio. THAs showed similar significant improvements in outcomes following first- and second-side surgery, regardless of sex. In contrast for TKAs, although male patients demonstrated the same pattern as the THAs, female TKAs displayed significantly less improvement in both OKS and its pain component following second-side surgery. Conclusion: Female patients undergoing second-side TKA showed less improvement in Oxford and pain scores compared to the first-side. This difference in outcome following second-side surgery did not apply to male patients undergoing TKA, or to either sex undergoing THA.