Clinical and Nonclinical Determinants of Simultaneous vs Staged Bilateral Total Knee Arthroplasty

Background: Patients requiring bilateral total knee arthroplasty (TKA) may undergo surgery either simultaneously or in a staged fashion. Contemporary trends in utilization, as well as clinical and nonclinical factors correlating with surgical selection, remain undefined. Methods: Adult patients who underwent simultaneous or staged bilateral TKA between 2016 and 2021 were identified. Patient characteristics were assessed, including clinical (age, sex, Elixhauser Comorbidity Index) and nonclinical factors (geographic region, insurance status, and social determinants of health). Multivariate logistic regression was performed to identify predictors of undergoing simultaneous bilateral TKA vs staged bilateral TKA. Results: < .05). Conclusions: The use of simultaneous bilateral TKA substantially declined between 2016 and 2021 relative to staged procedures. Surgical decisions were associated with both clinical (age, comorbidity burden, sex) and nonclinical (region, insurance, social determinants of health) factors.