Objective To investigate the effectiveness and safety of simultaneous bilateral total knee athroplasty (SB-TKA) for the treatment of patients aged 65 years and younger with bilateral knee osteoarthritis (KOA) by comparing with patients undergoing unilateral total knee arthroplasty (U-TKA). Methods A clinical data of patients, who underwent primary TKA for KOA and met the selection criteria between June 2019 and July 2023, was retrospectively analyzed, including 181 patients in the U-TKA group and 52 patients in the SB-TKA group. The baseline data of age, gender, disease duration, body mass index, and preoperative hemoglobin (Hb), knee range of motion (ROM), Oxford knee score (OKS), and visual analogue scale (VAS) score for pain were compared between the two groups, with no statistical significance (P>0.05). The operation time, postoperative hospital stay, and all complications related to knee arthroplasty were recorded. Hb was measured at 2 days after operation and the difference between pre- and post-operation was calculated. The knee function and pain were evaluated by using ROM, OKS score, and VAS score and compared between the two groups. Results The operation time and postoperative hospital stay duration were significantly shorter in the U-TKA group than in the SB-TKA group (P<0.05). The difference of Hb was significantly lower in the U-TKA group (P<0.05). All patients were followed up 12-61 months (mean, 37.2 months). There was no significant difference in follow-up time between the two groups (P>0.05). At last follow-up, the ROM, OKS score, and VAS score of both groups were better than the preoperative ones, and the differences were significant (P<0.05); there were significant differences between the two groups in the ROM and OKS score (P<0.05), while no significant difference was found in the VAS score (P>0.05). Mild complications were observed in 31 cases (17.13%) and severe complications in 3 cases (1.66%) in the U-TKA group, while mild complications were observed in 14 cases (26.92%) in the SB-TKA group, and no severe complications occurred. There was no difference in the incidences of mild and severe complications between the two groups (P>0.05).Conclusion In patients aged 65 years and younger with bilateral KOA, knee function and mobility can be significantly improved by SB-TKA. While patients had lower postoperative knee mobility and function scores compared with U-TKA, there was no significant difference in pain scores or overall incidence of complication. Strict patient selection and scientific perioperative management are important to achieve good effectiveness after operation in patients with SB-TKA.
Systematic review (SR) and meta-analysis, as the highest level of evidence-based medicine, are an indispensable part of guiding medical staff to make medical decisions. At the same time, the status of patients as shared decision-making is rising. At present, the results of SR and meta-analysis are mainly presented in the form of effect (relative risk or mean difference) and forest plot. The expression is not intuitive or professional. The process of evidence-based evidence guiding clinical decision-making lags behind, which cannot meet the needs of rapid decision-making. With the continuous progress in artificial intelligence and big data analysis tools, researchers have attempted to introduce visual presentations to improve the timeliness of clinical decision-making. Through the interpretation of the outcomes of SR and meta-analysis, this paper presents different visualization results from the perspective of patients and clinical decision-makers, which not only helps the majority of people without medical background understand clinical evidence more intuitively and participate in the process of clinical decision-making, but also helps improve residents' health literacy, promotes the dissemination and sharing of knowledge, and provides references for further promoting the technology of automatic decision-making system.