Incidence of Postoperative Infection Following Simultaneous Bilateral Knee Arthroplasty: A Systematic Review and Meta-Analysis

Abstract

Total knee arthroplasty is one of the most common orthopedic procedures. Simultaneous bilateral knee arthroplasty involves performing total knee arthroplasty on both knees in a single anesthetic session. This systematic review and meta-analysis followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020. A primary search was performed using PubMed, EBSCO, Scopus, Web of Science, Clarivate, and Google Scholar databases. Quantitative data synthesis was performed using MedCalc® Statistical Software version 20.115 to determine the pooled prevalence of the infection among patients who underwent simultaneous bilateral knee arthroplasty. The Newcastle-Ottawa Scale was used to assess study quality. We included 30 studies in our quantitative data synthesis, with a total population of 118,502 patients (237,004 knees). The pooled prevalence of superficial infection, deep infection, and unspecified surgical site infection was estimated to be 0.86% (95% confidence interval: 0.62-1.13%), 0.84% (95% confidence interval: 0.64-1.05%), and 1.18% (95% confidence interval: 0.45-2.27%), respectively. There was significant heterogeneity (I2 >50%) in all analyses, and inspection of funnel plots revealed a symmetrical distribution of plotted data. We found that the infection rates following simultaneous bilateral knee arthroplasty were relatively low but heterogeneous, as the data showed marked variability. Superficial infections were more common than deep infections; however, there was a small difference in their prevalence. Furthermore, the reliability of our findings was limited owing to significant heterogeneity.

Keywords: bilateral; infection; knee replacement; simultaneous; surgical site infection; total knee arthroplasty.

Figure 1. PRISMA flow chart summarizing the search and screening processes

Figure 2. A forest plot showing the pooled superficial infection rate in patients who underwent simBTKA

Figure 3. A forest plot showing the pooled deep infection rate in patients who underwent simBTKA

Figure 4. A forest plot showing the pooled unspecified SSI rate in patients who underwent simBTKA

Figure 5. A funnel plot showing the symmetrical distribution of the plotted superficial infection data

Figure 6. A funnel plot showing the symmetrical distribution of the plotted deep infection data

Figure 7. A funnel plot showing the symmetrical distribution of the plotted deep infection data