Should You Replace Two Knees at Once?

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Older man with knee pain with doctor

When osteoarthritis of the knee becomes so painful it limits your ability to walk, you might start thinking about having knee replacement surgery. But arthritis doesn’t usually affect only one knee at a time. If both of your knees ache and grind, should you consider having both of them replaced at the same time? Here’s what you need to know as you consider your options.

How Knee Replacement Surgery Works

The medical term for total knee replacement surgery is total knee arthroplasty, or TKA. This procedure involves removing structural portions of your knee joint and replacing them with mechanical parts. Because TKA removes all of the arthritis in the joint, your knee won’t hurt when you walk after getting it replaced and completing rehabilitation.

Traditionally doctors have replaced just one knee at a time, in two separate surgeries spaced months apart. This is called “staged” TKA. But some orthopedic surgeons now will offer to replace both knees at once. This procedure is called simultaneous bilateral total knee arthroplasty, or more commonly double knee replacement.

Candidates for Simultaneous Bilateral Knee Replacement

Not everyone qualifies for simultaneous bilateral TKA. In general, you must be experiencing significant, disabling arthritis in both knees. Many people who undergo double knee replacement have deformed legs due to the extensive effects of their arthritis. Simultaneous bilateral TKA may not be appropriate for a person with moderate osteoarthritis or even for someone whose arthritis is advanced but not debilitating.

Your age, overall health and other medical conditions also can influence whether or not you’re a candidate for double knee replacement surgery. In general, people over age 80 or those with cardiovascular conditions or a prior history of deep venous thrombosis (DVT) probably would be better off having their knees replaced in separate procedures.

Pros and Cons of Simultaneous Bilateral Knee Replacement

Traditional staged TKAs involve two surgeries, two episodes of anesthesia, two hospital stays, and two programs of rehabilitation over the course of a year or so. A key benefit of the simultaneous bilateral TKA is it exposes you to only one surgery and one episode of anesthesia, which can be safer and reduce the risk of infection in some people.

However, researchers have learned simultaneous bilateral TKA poses a higher post-operative risk of blood clots than the staged procedure. When a person has both knees replaced at once, you can imagine how difficult walking and rehabilitation become. Who wants to walk or participate in exercises with two swollen, painful, stiff knees, after all? This difficulty with walking and performing rehabilitation exercises causes double knee replacement patients to become more sedentary than their unilateral TKA counterparts.

When a person is sedentary after orthopedic surgery, their risk for developing deep vein thrombosis, or DVT, rises. DVTs can cause blood clots to travel from the legs to the lungs and cause breathing problems, even sudden death. This complication is preventable in most patients.

If you’re considering simultaneous bilateral knee replacement, you should discuss all of the risks and benefits with your doctor. Your overall health, co-existing medical conditions, and other factors might make simultaneous bilateral TKA a safer option for you than having two staged procedures. Or, you may find it better to go with the traditional staged process.

Double Knee Replacement Recovery

At an initial consultation with an orthopedic surgeon, you will discuss the pros and cons of a bilateral TKA. If you qualify and decide to proceed, the doctor’s office will schedule the surgery and provide you with complete pre- and post-op instructions.

You can expect to spend at least one night in the hospital after your surgery. After the surgery, you will begin rehabilitation almost immediately, while you’re still in the hospital. You will continue with physical therapy for several weeks after you go home.

Many knee replacement patients report that their level of post-operative pain is actually lower than the pain they were experiencing from the arthritis. You can be assured your surgical pain will be managed with medications during the initial recovery period.

Simultaneous bilateral total knee replacement can be a great choice for those with severe, disabling arthritis in their joints. With just a single trip to the operating room, you can literally get back on your feet and enjoy a robust lifestyle again.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2018 Dec 15
  1. Does Double Knee Surgery Make Sense for You? Harvard Health Publications. http://www.health.harvard.edu/pain/does-double-knee-surgery-make-sense-for-you
  2. Bilateral Total Knee Replacement. BoneSmart. http://bonesmart.org/knee/bilateral-total-knee-replacement/
  3. Total Knee Replacement. American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=A00389
  4. Activities After Knee Replacement. American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=a00357
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