Staggered bilateral knee arthroplasty: good or bad?

To the Editor: I read with interest the article by Memtsoudis et al. in the recent issue of ANESTHESIOLOGY on perioperative outcomes after unilateral and bilateral total knee arthroplasty. When the authors discuss about the issue of benefits and risks of simultaneous versus staged bilateral total knee arthroplasty, they have quoted an article by Sliva et al. In the original article by Sliva et al., the authors have evaluated 332 patients who had bilateral knee replacement, of which 241 patients had staggered bilateral knee replacement with 4 –7 days apart between the procedures during a single hospitalization. They found that patients who had sequential bilateral total knee replacement and staged bilateral knee replacement had 2.5 times more complications than the ones who had staggered bilateral knee replacement. The rates of complications for staggered bilateral knee replacement, sequential bilateral knee replacement, and staged bilateral knee replacement were 13, 35, and 31%, respectively. Major complications seemed to have occurred mostly in patients with staged bilateral knee arthroplasty. Hence, they had concluded that staggered bilateral total knee arthroplasty with procedures performed 4 –7 days apart in a single hospitalization was a safe option. In the article by Memtsoudis et al., the aforementioned article by Sliva et al. has been quoted wrongly as “in a study including 267 patients who underwent bilateral total knee arthroplasty during the same hospitalization, Sliva et al. found that bilateral procedures performed 4 –7 days apart were associated with higher risk of mortality and morbidity when compared with simultaneously performed procedures.” I am surprised by how the main conclusions in the original article could be completely misquoted. I hope in future, such inaccurate statements will be addressed right at the editing stage.