A Retrospective Comparison of Early Postoperative Pain after the First Vs Second TKA in Scheduled Staged Bilateral TKA

Yoshinori Ishii1, *, Hideo Noguchi1, Junko Sato1, Hana Ishii2, Ryo Ishii3, Shin-ichi Toyabe4
1 Ishii Orthopedic & Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama, 361-002, Japan
2 Kanazawa Medical University, School of Plastic Surgery, 1-1 Daigaku Uchinada, Ishikawa 920-0253, Japan
3 Sado General Hospital, 161 Chikusa Sado, Niigata 952-1209, Japan
4 Niigata University Crisis Management Office, Niigata University Hospital, Niigata, Japan

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© 2020 Ishii et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Ishii Orthopedic and Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama 361-0037, Japan,
Tel: +81-11-81-485-55-3519; Fax: +81-11-81-485-55-3520, E-mail:



Acute postoperative pain control after Total Knee Arthroplasty (TKA) is important given that poorly controlled, persistent pain can delay rehabilitation. The purpose of this study was to compare pain intensity during the early postoperative period (following the first and second surgeries) in patients who underwent bilateral, scheduled, staged TKAs.

Materials and Methods:

We enrolled 32 patients (64 knees) in this study and evaluated the number of requests for analgesic agents during the first 3 days after TKA, time to walking, and the Wong–Baker FACES pain assessment score (WBS).


Comparing the postoperative period following the first and second TKA, there were no significant differences in WBS 24, 48, and 72 h postoperatively. The frequency of requests, and the total number of requests for analgesics did not differ when comparing the first and second TKA, at any time point. The total number of analgesic requests exhibited a moderately strong, positive correlation between the first and second TKA (p < 0.001, r = 0.623). Patients’ WBS scores and requests for analgesics showed a moderately strong, positive correlation, but only at 24 h following the second TKA (p = 0.002, r = 0.567). After both TKAs, patients required a median of 1 day to resume walking.


Patients undergoing staged bilateral TKA experienced equivalent early postoperative pain when comparing their experience following their first and second TKAs. Therefore, regarding pain control following the second TKA, we recommend considering the analgesic administration schedule and requirements of the first TKA.

Keywords: Early postoperative pain, Staged bilateral total knee arthroplasty, Wong–Baker FACES pain assessment, Analgesics, Retrospective, Rehabilitation.