Single-stage bilateral total knee arthroplasty (ssBTKA) can be used for patients presenting with bilateral arthritis and may result in fewer systemic and wound complications compared with two, independent procedures. However, the safety of ssBTKA in the elderly remains controversial. Therefore, the purpose of this study was to compare early complications and transfusion rates following ssBTKA in patients ≤ 70 years old or > 70 years old. This retrospective chart review of 313 consecutive patients undergoing ssBTKA included 174 patients ≤ 70 years old and 139 patients > 70 years old. Perioperative variables and postoperative complications were compared with univariate analyses between age groups. Multivariate analyses were performed to determine risk factors for developing perioperative complications and transfusions. Compared with patients ≤ 70, patients > 70 had significantly lower body mass index (  0.12) and systemic complications ( > 0.54) were similar, 23% of patients > 70 required transfusion compared with only 8% of patients ≤ 70 ( < 0.001). Patients with preoperative anemia (  70 ( = 0.002), or diabetes mellitus ( = 0.007) were at 5.7, 3.3, and 2.9 times greater risk for requiring a transfusion, respectively. Patients > 70 undergoing ssBTKA have a similar complication profile to patients ≤ 70 years old, suggesting age should not be an absolute exclusion criterion for ssBTKA. However, the risk of transfusion was significantly higher in those > 70, despite lower tourniquet times. Treatment of preoperative anemia may decrease the risk of transfusion and could provide adequate safety for patients > 70 to undergo ssBTKA by an experienced surgeon.
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