Patient-reported dissatisfaction following second side in staged bilateral total knee arthroplasty: A systematic review

Table 1 Study information, all studies included for analysis had a minimum follow-up of 1 year after each total knee arthroplasty

Ref.	Participants, n (weight %)	Male, n	Female, n	Mean age, range	Interval between TKAs, mo (range)	PROMs	Conclusions
Suzangar et al[4], 2019	1001 (53.0%)	459	542	68.7	25.6 (0.1-174.0)	Satisfaction	More dissatisfaction after TKA2
Clement et al[6], 2019	454 (24.0%)	219	235	68.0	16.8 (7.2-44.4)	Satisfaction, OKS	No difference between knees
Abram et al[5], 2016	250 (13.2%)	84	166	66.0	23.0 (2.0-74.0)	OKS, WOMAC	Lower TKA2 OKS
Scott et al[9], 2014	70 (3.7%)	29	41	71.7	7.8 (2.0-25.0)	Satisfaction, OKS	No difference between knees
Tucker et al[10], 2021	114 (6.0%)	31	83	66.5	16.2 (11.4-22.8)	OKS	Females less satisfied than males
Pooled	1889 (100.0%)	822 (43.5%)	1067 (56.5%)	68 (38 to 92)	21.9 (0.1-174.1)

Age reported in years. OKS: Oxford knee score; TKA1: First side total knee arthroplasty; TKA2: Second side total knee arthroplasty; WOMAC: Western Ontario and McMaster universities.

Table 2 MINORS assessment

Ref.	A clearly stated aim	Inclusion of consecutive patients		Prospective collection of data	Endpoint appropriate to the aim of the study			Unbiased assessment of the study endpoint	Follow-up period appropriate to the aim of the study	Loss of follow-up less than 5%	Prospective calculation of the study size	Total
Suzangar et al[4], 2019	2		2	2		1	N/A		2	2	1	12
Clement et al[6], 2019	2		2	2		2	N/A		2	2	1	13
Abram et al[5], 2016	2		1	2		2	N/A		2	2	2	13
Scott et al[9], 2014	2		2	2		1	N/A		2	2	1	12
Tucker et al[10], 2021	2		2	2		2	N/A		2	2	1	13

The items are scored 0 (not reported), 1 (reported but inadequate) or 2 (reported and adequate). The global ideal score is 16 for non-comparative studies. N/A: Not applicable.

Table 3 Patients in each study reporting unequal satisfaction between knees after staged bilateral total knee arthroplasty

Ref.	Dissatisfied with TKA1, n	Dissatisfied with TKA2, n	Study RR	95%CI LL	95%CI UL	Study significance
Suzangar et al[4], 2019	61	91	1.49	1.18	1.88	0.025
Clement et al[6], 2019a	21	19	0.90	0.49	1.66	0.757
Abram et al[5], 2016a	15	32	2.0	1.11	3.61	0.0211
Scott et al[9], 2014	4	8	2.0	0.63	6.34	0.239
Tucker et al[10], 2021	0	5	12.0	0.67	215.26	0.0901
Pooled	101 (39.5%)	155 (60.5%)	1.49	1.17	1.90	0.001

¹Based on number of patients with OKS score differences between knees exceeding MCID; calculation assumes skewness of distribution < 2.

^aPairwise comparison of proportions with Chi square N-1 statistic 17.847, P < 0.0001.

Those that more satisfied with TKA2 are classified as “Dissatisfied with TKA1”; those that preferred TKA1 over TKA2 are classified as “Dissatisfied with TKA2” (n = 256, 13.6%). LL: Lower limit; TKA1: First side total knee arthroplasty; TKA2: Second side total knee arthroplasty; UL: Upper limit. Significance of the RR of dissatisfaction with TKA2 for each study with significance value set at P < 0.05.