Elderly population across the world tends to suffer from osteoarthritis of the knees which could seriously affect their health and quality of life. Total knee arthroplasty (TKA) is a surgical procedure used to reduce pain and improve quality of life and function in patients when the disease progresses and becomes severe. Simultaneous bilateral TKA is an effective and safe approach for selected patients. The possibility of having different satisfaction levels between the first and second knee in the early stage after Shuai Huang et al. assessed simultaneous bilateral TKA.

A total of 46 patients were retrospectively assessed in the Department of Joint Surgery, The First Affiliated Hospital of Sun Yat-sen University, China between March 2013 and March 2015. Typically, the surgeon executed first-side TKA (right knee), followed by TKA on the left knee. Tranexamic acid (TXA) (10 mg/kg) was administered intravenously, and the tourniquet was released after wound closure. The objective parameters comprising drainage volume and swelling evaluated by the circumference of the 10 cm above the patella; preoperative KSS (Knee Society Score), ROM (Risk of Mortality), and pain visual analog scale (VAS) and the preoperative and postoperative (1^st, 3^rd, and 7^th days) subjective parameters comprising pain, patient satisfaction and VAS of the first and second surgeries for each knee were investigated.

On comparison of simultaneous bilateral TKA, the first-side TKA (right knee) showed lower mean drainage volume (p < 0.05). However, the swelling of the knee was higher on the 1^st, 3^rd, and 7^th postoperative days (p < 0.05). Also, the first-side TKA scored lower in satisfaction VAS, but higher in pain VAS at the 1^st, 3^rd, and 7^th postoperative days.  As per the patient satisfaction scores, 2 (4.4%) of the 46 patients rated first-side TKA higher than second-side TKA, 34 (73.9%) of the 46 patients rated second-side TKA higher than first-side TKA, and 10 (21.7%) of the 46 patients rated their satisfaction as the same for both knees.

Overall, there was better patient satisfaction with the second knee in the early stage following simultaneous bilateral TKA. This may supplement some considerations for surgeons opting for simultaneous bilateral TKA for patients suffering from osteoarthritis in both knees.