Perioperative considerations of bilateral total knee replacement: a review.

Bilateral total knee replacement is becoming one of the more commonly performed orthopedic procedures for patients with advanced arthritis of both knees. The surgeon may decide to operate on both knees simultaneously, sequentially, or in a staged manner. The safety of this procedure is still debated due to wide variation in the studies and their endpoints. Although there are advantages with bilateral procedures such as reduced cost and improved rehabilitation, there is definite evidence of increased cardiopulmonary, thromboembolic, neurological, bleeding, and transfusion complications with bilateral knee replacement versus unilateral knee replacement, particularly in elderly patients with comorbidities.