The safety and cost-analysis of simultaneous versus staged bilateral total knee arthroplasty in a Taiwan population

Q: What clinical question does the study address about bilateral knee osteoarthritis surgery?

It evaluates whether simultaneous bilateral total knee arthroplasty (SiTKA) or staged total knee arthroplasty (StTKA) is the better treatment option for patients with advanced bilateral knee osteoarthritis, focusing on safety and cost.

Q: How were patients selected and what time period was analyzed?

Patients undergoing SiTKA or StTKA for osteoarthritis or spontaneous knee osteonecrosis were retrospectively reviewed using Taipei Veterans General Hospital data from January 2011 to December 2016.

Q: Which outcomes and cost components were compared between SiTKA and StTKA?

Outcomes included length of stay, transfusion rate, early postoperative complications, 30- and 90-day readmission rates, 1-year reoperation rate, and the indication for reoperation. Costs included national health insurance reimbursement, procedure costs, and net income per case.

Sep 29, 2026

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Advanced bilateral knee osteoarthritis leaves uncertainty about whether simultaneous bilateral total knee arthroplasty (SiTKA) or staged total knee arthroplasty (StTKA) is the preferred approach. A retrospective big-data study using Taipei Veterans General Hospital records (2011–2016) compared outcomes including length of stay, transfusion rate, early complications, 30- and 90-day readmissions, 1-year reoperations, and reoperation indications, plus total costs under Taiwan’s national health insurance system.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages5

Reading Time13 min

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Introduction

Methods

Results

Conclusion

Keywords

. J Chin MedAssoc Original article The safety and cost-analysis of simultaneous versus staged bilateral total knee arthroplasty in a Taiwan population Te-Feng Arthur Choua,b, Hsuan-Hsiao Maa,b, Chi-Wu Tsaia,b, Shang-Wen Tsaia,b,* , Cheng-Fong Chena,b, Fang-Yao Chiua,b, Po-Kuei Wua,b, Wei-Ming Chena,b aDepartment of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; bDepartment of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC Abstract Background: In patients with advanced osteoarthritis (OA) of the bilateral knees, uncertainty remains as to whether simultaneous bilateral total knee arthroplasty (SiTKA) or staged TKA (StTKA) is the treatment of choice. The purpose of this study was to investigate the safety and relative cost of SiTKA vs StTKA in Taiwan patients. Methods: Using the Big Data Center of Taipei Veterans General Hospital, we retrospectively reviewed all patients who underwent SiTKA or StTKA due to OA or spontaneous osteonecrosis of the knee from January 2011 to December 2016. We assessed length of stay, transfusion rate, early postoperative complications, 30- and 90-day readmission rate, 1-year reoperation rate, and the indication for reoperation. Furthermore, we analyzed the total cost of the two groups, including reimbursement from the national health insurance (NHI), cost of the procedures, and net income from each case. Results: A total of 2016 patients (1565 SiTKA and 451 StTKA) were included in this study. The two groups had no significant differences in rates of complications, 30-and 90-day readmission, or 1-year reoperation. The length of stay was on average 5.0 days longer for StTKA (p < 0.01) . In terms of cost, all categories of medical costs were significantly lower for SiTKA, while the net hospital income was significantly higher for StTKA. Conclusion: SiTKA is a safe and cost-effective surgery. Both SiTKA and StTKA have similar rates of postoperative complications, readmission and reoperation, but SiTKA significantly reduces medical expenses for both the patient and the NHI. Keywords: Bilateral total knee arthroplasty; Complications; Cost-effective analysis; Osteoarthritis; Taiwan 1. INTRODUCTION Osteoarthritis (OA) is the most common musculoskeletal disorder worldwide, affecting over 303 million people.1 In particular, OA of the knee is a progressive joint disease characterized by chronic pain and functional impairment.1 When conservative treatment has failed, total knee arthroplasty (TKA) is commonly used to treat severe knee OA.2 Primary, unilateral TKA is a cost-effective surgery that relieves pain and improves quality of life for patients with severe OA.3–5 Of those undergoing unilateral TKA, 37% will receive a TKA for the contralateral knee.6 Therefore, when OA is present in bilateral knees, bilateral TKA may be warranted.2,3,7 The decision to perform simultaneous * Address correspondence. Dr. Shang-Wen Tsai, Department of Orthopaedicsand Traumatology, Taipei Veterans General Hospital, 201, Section 2, Shi-Pai Road, Taipei 112, Taiwan, [ROC. E-mail address: swtsai.vghtpe@gmail.com](ROC. E-mail address: swtsai.vghtpe@gmail.com) (S.-W. Tsai). Conflicts of interest: Dr. Wei-Ming Chen, an editorial board member at Journal of the Chinese Medical Association, had no role in the peer review process of or decision to publish this article. The other authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article. Journal of Chinese Medical Association. (2023) 86: 494-498. Received July 13, 2022; accepted October 11, 2022. doi: 10. 1097/JCMA.0000000000000892. Copyright © 2023, the Chinese Medical Association. This is an open access article under the CC BY-NC-ND license ([http://creativecommons.org/licenses/](http://creativecommons.org/licenses/)[ ](http://creativecommons.org/licenses/)[by-nc-nd/4.0/](by-nc-nd/4.0/)) (SiTKA) or s

FAQs

What clinical question does the study address about bilateral knee osteoarthritis surgery?

It evaluates whether simultaneous bilateral total knee arthroplasty (SiTKA) or staged total knee arthroplasty (StTKA) is the better treatment option for patients with advanced bilateral knee osteoarthritis, focusing on safety and cost.

How were patients selected and what time period was analyzed?

Patients undergoing SiTKA or StTKA for osteoarthritis or spontaneous knee osteonecrosis were retrospectively reviewed using Taipei Veterans General Hospital data from January 2011 to December 2016.

Which outcomes and cost components were compared between SiTKA and StTKA?

Outcomes included length of stay, transfusion rate, early postoperative complications, 30- and 90-day readmission rates, 1-year reoperation rate, and the indication for reoperation. Costs included national health insurance reimbursement, procedure costs, and net income per case.

Sep 29, 2026

Upload by Putri