Conference Coverage

Staged Bilateral TKA: 10- to 11-Week Interval Between Procedures Linked to Lower Complication Risk

Edited by:
Brian McCurdy

Key Highlights

  • The analysis included 91,407 adults undergoing bilateral TKA within 1 year, including 29,324 simultaneous procedures.
  • The modeled interval thresholds were 9.7 weeks for major adverse events and 10.6 weeks for venous thromboembolism.
  • Procedures staged before these respective thresholds were associated with higher adjusted odds of both outcomes.
  • The authors emphasized individualized patient risk stratification when determining surgical timing.

Intervals of approximately 10–11 weeks between staged bilateral total knee arthroplasty (TKA) procedures were associated with lower postoperative complication risk in a national healthcare database analysis. Patients undergoing staged procedures before the identified thresholds had higher rates of major adverse events and venous thromboembolism (VTE). The abstract was presented at the American Association of Hip and Knee Surgeons Annual Meeting 2026 in Dallas.

The investigators sought to clarify the minimum interval between procedures at which complication risk decreases. Their rationale was that surgeons often stage bilateral TKAs to mitigate the increased complication risk associated with simultaneous surgery, but the optimal interval remains uncertain.

Researchers queried a national healthcare database for adults undergoing primary elective TKA from 2016 through 2023, then identified patients who underwent bilateral procedures within 1 year. Multivariable logistic regression with restricted cubic splines modeled the relationship between the interval in weeks and 90-day postoperative complications. Major adverse events included myocardial infarction, stroke, or mortality.

Markov Chain Monte Carlo simulations identified the minimum interval at which the modeled risk of each complication decreased. Investigators then used multivariable logistic regression to compare outcomes among patients whose procedures occurred above or below each threshold.

Study Findings

The cohort included 91,407 patients, of whom 29,324 (32.1%) underwent simultaneous bilateral TKA. The mean age was 65 years, and 59% were female. The analysis identified a minimum interval of 9.7 weeks for major adverse events and 10.6 weeks for VTE. Among patients undergoing staged bilateral TKA before the major adverse event threshold, the event rate was 0.37%, compared with 0.26% among those above the threshold. The adjusted odds ratio was 1.69 (95% CI, 1.32–2.16).

For VTE, the corresponding rates were 1.51% before the identified threshold and 0.84% above it, with an adjusted odds ratio of 1.77 (95% CI, 1.56–2.01). Both comparisons showed significantly elevated risk with shorter intervals.

Clinical Implications

The authors report that the analysis supports a minimum interval of about 10–11 weeks between staged bilateral TKAs to reduce complication risk. They nevertheless emphasized that individualized patient risk stratification remains essential when selecting the timing of the second procedure.

Expert Commentary

“The present analysis identified a minimum interprocedural interval of 10 to 11 weeks for staged bilateral TKA to reduce the risk of complications. However, individualized patient risk stratification remains essential when determining the optimal timing of staged TKAs,” the researchers concluded.

Reference

Lieberman JR, Orringer M, Lim MA, et al. The optimal time interval between staged bilateral total knee arthroplasty procedures. Paper #13. Abstract presented at the American Association of Hip and Knee Surgeons Annual Meeting, November 5–8, 2026, Dallas, TX.