Bilateral vs Unilateral Total Knee Arthroplasty: A Patient-Based Comparison of Pain Levels and Recovery of Ambulatory Skills

Two important questions remain in simultaneous bilateral total knee arthroplasty (TKA). Is bilateral TKA significantly more painful and is physical recovery significantly more difficult compared with unilateral TKA? A retrospective matched-pair analysis compared 59 bilateral and 59 unilateral TKA patients based on age, sex, diagnosis, surgeon, and surgery date. Analog pain scores, narcotic use, ambulatory distances, and rehabilitative milestones were recorded. Bilateral patients' pain scores were 1 point higher during day 1 with subsequent equal scores. Narcotic use was 20% higher for the first 48 hours but equalized after that period. Ambulatory milestones lagged behind by 36 hours. Patients wishing to pursue bilateral TKA can proceed without pain, use of narcotics, and walking distance significantly different than unilateral TKA.