Knee Replacement: Can You Have Both Knees Replaced at the Same Time?

Can you have knee replacement on both knees at the same time?

Yes, it is possible to have both knees replaced during a single surgical procedure, a practice known as simultaneous bilateral total knee replacement, though it is a less common approach than staged procedures and involves specific considerations for patient health, surgical risk, and rehabilitation.

Understanding Bilateral Knee Replacement

Total knee replacement (TKR), or total knee arthroplasty (TKA), is a highly effective surgical procedure to relieve pain and restore function in severely damaged knee joints. When both knees are affected by severe arthritis or injury, the question often arises about addressing both simultaneously. This is referred to as bilateral knee replacement.

There are two primary approaches to bilateral knee replacement:

• Simultaneous Bilateral Knee Replacement: Both knees are operated on during the same surgical session, under a single anesthetic.
• Staged Bilateral Knee Replacement: The two knee replacement surgeries are performed at separate times, typically weeks or months apart, allowing for recovery and rehabilitation of the first knee before the second is addressed.

The decision between these two approaches is complex and is made in close consultation with an orthopedic surgeon, taking into account the patient's overall health, lifestyle, and the severity of their knee conditions.

Advantages of Simultaneous Bilateral Knee Replacement

While not suitable for everyone, simultaneous bilateral knee replacement offers several potential benefits:

• Single Anesthesia Exposure: Patients undergo anesthesia only once, reducing the cumulative risks associated with multiple exposures.
• One Hospital Stay: Eliminates the need for two separate hospital admissions, which can be more convenient and potentially reduce overall hospital-related costs.
• Combined Rehabilitation Period: Although the initial recovery is more intense, the overall rehabilitation process is consolidated into one period, meaning patients only have to go through the most challenging recovery phase once.
• Faster Return to Full Function (Overall): Once the recovery period is complete, both knees are rehabilitated, potentially allowing for a quicker return to full functional activities compared to waiting for two separate recovery cycles.
• Psychological Benefit: Some patients prefer to get both surgeries "over with" at once, avoiding the anticipation and recovery of a second procedure later.

Disadvantages and Risks of Simultaneous Bilateral Knee Replacement

Despite the potential advantages, simultaneous bilateral knee replacement carries higher risks and demands more from the patient's body than a unilateral (single knee) or staged bilateral procedure. These include:

• Increased Surgical Time: Operating on both knees simultaneously doubles the time the patient is under anesthesia and the duration of the surgery itself.
• Higher Blood Loss: Operating on two major joints at once can lead to significantly more blood loss, increasing the risk of needing a blood transfusion.
• Elevated Risk of Complications:
  • Cardiovascular Complications: Increased strain on the heart, higher risk of heart attack or stroke, particularly in patients with pre-existing cardiac conditions.
  • Pulmonary Complications: Higher risk of blood clots (deep vein thrombosis - DVT) and pulmonary embolism (PE), as well as pneumonia.
  • Infection: While rare, the risk of infection, though still low, is theoretically increased with longer surgical times.
  • Kidney Issues: In rare cases, the stress of a prolonged surgery can impact kidney function.
• More Challenging Immediate Rehabilitation: Recovering from two knee replacements at once means both legs are recovering simultaneously, making initial mobility, weight-bearing, and activities of daily living significantly more difficult and painful.
• Greater Need for Post-Acute Care: Patients often require a longer stay in a rehabilitation facility or skilled nursing facility after simultaneous bilateral surgery compared to those who undergo unilateral or staged procedures.

Who is a Candidate for Simultaneous Bilateral Knee Replacement?

Patient selection is crucial for the success and safety of simultaneous bilateral knee replacement. Ideal candidates typically share several characteristics:

• Excellent Overall Health: Patients must be in robust health with no significant pre-existing medical conditions, especially those affecting the heart, lungs, or kidneys.
• Younger Age: Generally, younger patients (e.g., under 70-75 years old) without major comorbidities are better candidates as their bodies can typically withstand the surgical stress and intense rehabilitation more effectively.
• Healthy Body Mass Index (BMI): Patients who are not significantly overweight or obese tend to have lower surgical risks and better outcomes.
• Strong Support System: A robust support network at home is essential, as the initial recovery can be very challenging and require significant assistance.
• Motivation and Compliance: Patients must be highly motivated and committed to a rigorous and sometimes painful rehabilitation program.
• Symmetry of Pain/Dysfunction: Both knees should be causing significant, debilitating pain and functional limitation, justifying the need for simultaneous intervention.

Your orthopedic surgeon will conduct a thorough medical evaluation, including a review of your medical history, physical examination, and potentially additional diagnostic tests, to determine if you are a suitable candidate.

The Surgical Procedure

Simultaneous bilateral total knee replacement is a major orthopedic surgery performed by skilled orthopedic surgeons. Both knees are prepared and draped in a sterile manner. The damaged bone and cartilage are removed from both the thigh bone (femur) and shin bone (tibia), and sometimes the kneecap (patella). These surfaces are then replaced with prosthetic components typically made of metal alloys and high-grade plastics. The procedure is complex and requires meticulous attention to detail to ensure proper alignment and function of both new knee joints.

Recovery and Rehabilitation

The recovery period following simultaneous bilateral knee replacement is intensive. Patients will experience significant pain and swelling in both knees. Physical therapy begins almost immediately after surgery, focusing on restoring range of motion, strength, and the ability to bear weight.

Key aspects of recovery include:

• Pain Management: Aggressive pain management strategies are employed to make rehabilitation tolerable.
• Early Mobilization: Getting out of bed and beginning to move both knees soon after surgery is critical to prevent complications and promote healing.
• Intensive Physical Therapy: This is paramount. Patients will work with physical therapists daily to regain strength, flexibility, and walking ability. This may involve inpatient rehabilitation for several weeks before transitioning to outpatient therapy.
• Adaptive Equipment: Initially, patients will rely heavily on assistive devices such as walkers or crutches, and may need modifications at home to accommodate limited mobility (e.g., elevated toilet seats, shower chairs).
• Long-Term Commitment: Full recovery can take several months to a year, requiring ongoing commitment to exercise and rehabilitation.

Making the Decision

The decision to undergo simultaneous bilateral knee replacement is a highly personal one that must be made in close collaboration with your healthcare team. Your orthopedic surgeon will discuss the pros and cons specific to your health profile, explaining the potential risks and benefits in detail. They will also consider the resources available for your post-operative care and rehabilitation.

It's important to ask questions, understand the recovery process fully, and feel confident in your surgeon's recommendation. For many, a staged approach is a safer and more manageable option, allowing for focused recovery on one knee at a time. However, for carefully selected individuals, simultaneous bilateral knee replacement can be a viable and effective path to restored function in both knees.

Conclusion

While challenging, having knee replacement surgery on both knees at the same time is a recognized and successful procedure for specific, well-selected patients. The advantages of a single surgical event and consolidated recovery must be carefully weighed against the significantly increased surgical risks and the intensity of the immediate post-operative rehabilitation. Always consult with a qualified orthopedic surgeon to determine the safest and most appropriate treatment plan for your individual circumstances.