Everyone seems to know someone who’s had knee replacement surgery.
The procedure is on the rise for both sexes, with the rate of total knee replacement doubling among women age 45 and older, according to the Centers for Disease Control and Prevention.
But just as no two patients are alike, not all knee replacement surgeries are the same.
So when a patient with two bad knees asks whether she can have both knees replaced at once—a surgery known as simultaneous bilateral knee replacement—the answer isn’t a simple yes or no.
What’s her age? How is her overall health? How quickly does she want to get home after surgery? And how bad are the two knees?
All of these questions come into play, according to Susan Day, MD, an orthopaedic surgeon and knee replacement specialist with Spectrum Health Medical Group.
“It makes a difference whether it’s a partial or a total (knee replacement),” Dr. Day said. “And it makes a difference what kind of patient you’re dealing with” and what the patient’s goals are.
Total knee replacements
Simultaneous bilateral
“There are some folks, I think it might make sense to do two (total replacements) at the same time, just because they have such deformity of both knees,” Dr. Day said.
Although painful, the rehabilitation process is easier for these patients, she said, because the two knees can work together. You can’t ride an exercise bike, for example, with one knee needing rehab and the other knee still waiting for surgery and perhaps unable to straighten all the way.
For most patients, however, having both replaced at once is not the best option.
“Simultaneous bilateral knee replacement is sometimes really painful and difficult for the patient,” Dr. Day said.
What’s more, some patients’ general health makes it “just too risky to do two under the same anesthetic.”
Health conditions that increase the risk for post-operative complications include morbid obesity, coronary artery disease, diabetes, kidney failure, obstructive pulmonary disease and advanced age.
Staged two days apart
Dr. Day’s preference, when a patient needs two total knee replacements, is to stage the surgeries two days apart. She’s been using this strategy for about 10 years.
Compared to replacing both knees at once, spacing the surgeries two days apart has several advantages, Dr. Day said:
- It lowers the risk of complications, such as increased blood loss during surgery or persistent wound drainage.
- It’s less painful for patients because it allows the pain in the first knee to fade a bit before the second knee is operated on.
- It lets patients rehab both knees at the same time, shortening the total recovery time.
- It allows doctors to postpone or cancel the second surgery if a medical issue arises that makes a second surgery inadvisable.
But the two-days-apart approach isn’t right for all patients. Some need time to rehab the first knee before having the second one replaced.
Others simply want to get home as soon as possible, Dr. Day said.
“If you do one knee, most of those folks will go home. If you do two, whether under the same anesthetic or separated by a couple of days, most of those folks will go to the rehab unit. … For some folks, that’s a deal breaker. They don’t want to go to rehab; they want to go home.”
Staged six weeks apart
Staging the two knee replacement surgeries six weeks apart is another option. This is the strategy Bryan Kamps, MD, prefers. Dr. Kamps is an orthopaedic surgeon at Spectrum Health Medical Group specializing in knee and hip replacements.
“It’s hard to get two knees working the way they should, both of them, at the same time,” he said. “It’s harder to get moving.”
Separating the two surgeries by six weeks lets patients do their rehab either with a home health aid or at a physical therapy center.
Partial knee replacements
In a partial knee replacement, only part of a damaged knee is replaced. Because this procedure is less invasive than a total knee replacement, it allows for different options, Dr. Day said.
“With partial replacements I do them bilateral, under the same anesthetic,” she said. “There’s less blood loss associated with a partial than with a full. And those patients usually I just keep overnight in the hospital and they go home the next day.”
Doing two partial knee replacements at once is a common procedure for Dr. Day, who, like Dr. Kamps, performs all surgeries at the Center for Joint Replacement at Spectrum Health Blodgett Hospital.
The bottom line
The takeaway for patients with two bum knees is if they ask to have both replaced in a single surgery, the answer might be complicated.
“Ultimately, it’s a discussion between the patient and the doctor—and the primary care physician,” Dr. Day said. “The most important thing is to have an uneventful surgery.”
I really did appreciate the various pieces of advice here. I am having my knee replacements a week apart, and, now, I understand more about my doctor’s decision to do so.
Hi Peggy! Thanks for being a Health Beat reader and for your kind comment. We’re glad to be of help. Best wishes to you with your knee replacements! 🙂 Cheers, Cheryl
I had my knees done six weeks apart. The first one is good at 6 months but the second needs to catch up. BUT I’m back to work dealing with swelling in the second on a massive scale.
I am 45 years old and have a consult on Friday to see if I am a candidate for the bilateral partial knee recoveries. It will depend on the most recent X-rays and how much arthritis is now seen. I had cortisone injections in both k red today, and have been doing PT for the past year. I have also lost 37 pounds which puts me at a 24.5 BMI, it is in the high end of the normal weight range, but not overweight. I would like to go about my daily life functions without pain, particularly when it comes to stairs and getting up from a seated position, especially when I am on the ground. I know I am on the young side and may need surgery again in the future, but I would like to be active for the next 20 years, and if I need them again in 20 years i will start my retirement that way!
Would love to here if you did a bilateral partial knee replacement at the same time. Also, has anyone went in for a partial and then had a total knee replacement done? My consult is this Friday, and I would love to schedule in November to miss a minimal amount of work.
I had both replaced at age 67, I was blessed to be in great health & wo weigh or health problems. As I live alone I had to go to rehab for 9 days, then I did the rest of therapy at home. Dad them done on mar.17 & was planting garden on may 17th. I was truly blessed!!!!
Hi Richard thank you for sharing.
I recently learned my knees are bone on bone and need to be replaced. I am 61 and am in decent physical shape. I don’t have any health risk that I am aware. I’m getting ready to schedule my surgery and strongly considering doing both knees at the same time. Do you have any advice for me?
The pain is excruciating for the first 3weeks not trying to discourage but on the other hand if I did one I would not go back for the other. So do it and get it over with. Good luck
I had a tkr 8 wks ago why is my wound stinging now and swollen plus my ankle
Sorcha
All sounds good
I had bilateral partial knee replacement surgery on October 29th. I went home the next day due to covid. I am in a lot of pain, nausea and diarrhea. Oxycodone doesn’t help at all so I just use ice and tylenol. Celebrex also. I have to give myself an injection twice a day to prevent clots. homecare is coming today.
Had mine done 27th was in hospital 2 weeks due to pain I been in rehab 3 weeks now the stiffness still there pain let up but having very hard time
Worst and longest pain I’ve ever had in my life. TKR on left 8 years ago. I just had 2nd emergency arthroscopic knee surgery on right, due to swelling. In horrible pain as if right knee done. This pain is not controlled at all. I would NEVER EVER have this surgery if I wasn’t guaranteed, in writing, proper pain meds.
I’ve had MAKO TKR to both knees a year apart. Whilst I recovered ok from the first and am recovering from the 2nd 6 weeks ago the initial post op pain is absolutely the worst ever. My advice to anyone considering this surgery is get your meds regime organised before surgery. I have a host of drug allergies which made the first surgery problematical, but the pain was more under control second time around. I also have 2 false hips. Don’t just breeze into knee surgery. Research, research, research Good luck!
I had bilateral total knee replacement six days ago. I am a 48 year old female. This ain’t for punks. The pain has been excruciating, mainly because you don’t have a good leg to stand on and support yourself while you try to do the most basic of moves (go from seated to standing, lower yourself onto the toilet) and I have asked myself a number of times if I should have done things a bit differently. At the end of the day, from a timing perspective, this is just what worked best for me. Days 3 and 4 were the worst as that’s when the nerve blocks and anesthesia started to completely wear off. Days five and six it seems that I really turned the corner. It’s still pretty painful, of course, but I’ve started physical therapy, and I am noticing immediate benefit from that. Being able to bend my knee and get some additional range of motion, makes me more comfortable in the bed, for example. However, the PT also makes me really sore so walking is more of a challenge than it had been. I have a very long way to go, but I am optimistic. Both at once was the right decision for me. Prayers for a speedy and complete recovery to all of us!