Unilateral vs. simultaneous bilateral cruciate-retaining total knee arthroplasty: Mid-term clinical, functional, and radiological outcomes

Year 2025, Volume: 42 Issue: 3, 279 - 284, 30.09.2025

Göksel Şahiner , Bedirhan Albayrak , Zafer Orhan

Abstract

This study aimed to evaluate the clinical, functional, and prosthesis survival outcomes of patients who underwent cruciate-retaining total knee arthroplasty (TKA) at a single center by a single surgeon, with a minimum follow-up of 13 months. Additionally, the influence of comorbidities and cold sensitivity on mid-term outcomes was investigated. A total of 41 patients (50 knees) who underwent TKA for varus-aligned gonarthrosis were retrospectively analyzed. Clinical and functional outcomes were assessed using WOMAC, Clinical and Functional American Knee Society Scores (C-AKSS, F-AKSS), SF-12 MCS and PCS, and radiological evaluation was performed using the KSRES scoring system. Patients were grouped based on surgery type (unilateral vs. bilateral), etiology, prosthesis brand, total valgus angle (TVA), and presence of cold sensitivity. Comparative statistical analyses were conducted among subgroups. Bilateral TKA was associated with significantly higher erythrocyte transfusion requirements (p = 0.003), worse WOMAC (p = 0.032), SF-12 MCS (p = 0.045), and KSRES scores (p = 0.029) compared to unilateral TKA. No significant differences were found between implant brands in terms of clinical or radiological outcomes (p > 0.05). Subgroup comparisons based on TVA categories showed no statistically significant differences (p > 0.05). Patients with cold sensitivity had significantly worse WOMAC (p = 0.041) and SF-12 MCS (p = 0.048) scores. Diabetes mellitus or coronary artery disease did not significantly affect KSRES or functional scores (p > 0.05). Cruciate-retaining TKA is a safe and effective procedure. However, simultaneous bilateral TKA may lead to inferior mid-term outcomes and increased transfusion needs. Based on our findings, unilateral TKA may be more favorable in routine practice, particularly in patients without strong bilateral indications.

Keywords

Knee Replacement Arthroplasty , Knee Osteoarthritis , Knee Prostheses

Ethical Statement

It was conducted with the approval of the Local Ethics Committee of Düzce University Faculty of Medicine. This study was conducted in compliance with the Helsinki Declaration as revised in 2013.

Supporting Institution

None

Thanks

We would like to sincerely thank Hazal Albayrak for her invaluable support and contribution to this study. Her assistance in data analysis was essential to the success of this project.

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