© 2018, Acta Orthopaedica Belgica.The purpose is to evaluate feasibility of simultaneous TKA in comparison with staged and unilateral procedures. Number of patients included: 72 simultaneous bilateral, 61 staged bilateral and 222 unilateral TKAs were included. The mean age in the simultaneous group was lower than the other groups. Heart failure as comorbidity was observed less in the simultaneous TKA group than the other two groups. There was no significant difference between simultaneous and staged groups with respect to postoperative WOMAC and SF36 scores. Rates of thrombotic complications and mortality were not different. There was no significant difference in terms of wound healing, periprosthetic infection and TKA revision rates. Younger age and heart failure as a comorbidity were found to be decisive in the selection of simultaneous procedure. Thus, in the case of advanced bilateral knee osteoarthritis, simultaneous bilateral TKA should be performed after a proper preoperative risk assessment when there is a medical rationale, or the patient's personal preference. In the light of aforementioned conditions, hesitancy about simultaneous TKA seems unnecessary.