Staged bilateral knee replacements

It is a shame that Gabr et al did not include any reference to age or employment in their paper. Employment is surely one of the most important functional outcomes for many knee replacement patients and, as retirement ages rise, will become more so. Staged bilateral replacements might be thought to increase the duration of sickness absence from work and potentially push this to the point where patients end up on unpaid leave or even unemployed. However, if staging the procedure improves rehabilitation and reduces the proportion of working age patients who do not recover sufficiently to return to work, it might be advantageous economically. Clinical specialists should move towards considering return to an economically productive life as the desired end point to their interventions and therefore an important outcome to measure in studies of functional impact of surgery.