BASK and research: Single-stage versus two-stage bilateral knee replacement, a randomised control trial

At the recent BASK Annual General Meeting in Slough, UK, a debate was aired on single-stage versus two-stage bilateral knee replacement. This is currently a topical issue as it can be seen that there are economic benefits to a single-stage procedure, but is it at the expense of patient safety? Paul Allen argued for, but stressed that single-stage can be simultaneous with two surgical teams operating at the same time, or sequential with one team operating on one side and then the other. He strongly advocated the former. Jonathan Noble argued against, stressing the lack of an evidence base. He concluded by suggesting that BASK should sponsor a randomised controlled trial on single-stage versus two-stage knee replacement. It was clear that there was no firm view about which is the correct approach, although a few individual surgeons did. In the case of surgical equipoise (where there is no clear indication which approach is better) then it is ethical to consider a randomised controlled trial as the study design.