In-Hospital Transfusion Burden and Length of Stay After Unilateral, Simultaneous Bilateral, and Staged Bilateral Total Knee Arthroplasty

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Günay M. C., Demir M., Kara H., Eren K.

Journal of Orthopaedic Reports, cilt.1, ss.1-7, 2026 (Scopus)

• Yayın Türü: Makale / Tam Makale
• Cilt numarası: 1
• Basım Tarihi: 2026
• Doi Numarası: 10.1016/j.jorep.2026.101015
• Dergi Adı: Journal of Orthopaedic Reports
• Derginin Tarandığı İndeksler: Scopus
• Sayfa Sayıları: ss.1-7
• Açık Arşiv Koleksiyonu: AVESİS Açık Erişim Koleksiyonu
• Eskişehir Osmangazi Üniversitesi Adresli: Evet

Özet

Background: Total knee arthroplasty (TKA) may be performed as a unilateral procedure or as a bilateral intervention,

either simultaneously or in a staged manner. Although simultaneous bilateral TKA may reduce cumulative

hospitalization, concerns remain regarding increased perioperative blood loss and transfusion burden.

Comparative interpretation of these strategies is further complicated by real-world differences in patient selection

and perioperative practice patterns.

Methods: This retrospective cohort study included patients who underwent primary unilateral, simultaneous

bilateral, or staged bilateral TKA at a tertiary referral center between December 2014 and July 2024. All procedures

were performed by a single surgeon. Perioperative erythrocyte suspension (ES) transfusion requirement

and length of hospital stay were evaluated. Analyses were descriptive and comparative, without causal inference.

Results: A total of 219 patients were included, comprising 108 unilateral, 95 simultaneous bilateral, and 16

staged bilateral TKA cases. Perioperative ES transfusion rates differed significantly among the three surgical

strategies, with the highest proportion of transfused patients observed in the simultaneous bilateral TKA group,

followed by the staged bilateral and unilateral groups. Length of hospital stay also differed significantly among

the groups, with the shortest hospitalization observed after simultaneous bilateral TKA and the longest after

unilateral TKA.

Conclusions: In this real-world retrospective cohort, simultaneous bilateral TKA was associated with a higher inhospital

transfusion burden, whereas unilateral TKA was associated with a longer hospital stay. These differences

appear to reflect not only operative extent but also patient selection and institutional perioperative practice

patterns. Accordingly, the findings should be interpreted as descriptive rather than as evidence of definitive

superiority of one surgical strategy over another.