Double Knee Replacement

In some cases, a surgeon may suggest double knee replacement surgery. Doctors recommend this procedure for patients who suffer from severe arthritis in both knees. About one-third of all patients who receive a knee replacement suffer from degenerative disease in the other joint. 

The surgery involves either of two approaches: a simultaneous bilateral knee replacement, during which both knees are replaced at the same time; or a staged bilateral knee replacement, during which each knee is replaced at a different time—often days or weeks later. According to the journal AORN Journal (Association of periOperative Registered Nurses), roughly 6 percent of patients have both knees operated on simultaneously. The operation may involve any combination of total knee replacement (TKR) or partial knee replacement (PKR). 

Simultaneous Bilateral Knee Replacement

The primary advantage of a simultaneous procedure is that there is a lower infection rate associated with a single surgical event compared to two—along with a single application of anesthesia. What’s more, the patient must endure only a single recovery and rehab period (rather than two). A disadvantage is that the procedure takes longer to perform. It typically lasts 3-4 hours rather than the 1½-2 hours generally required for a standard knee replacement that involves one knee.

The longer surgical time and additional anesthesia aren’t recommended for patients with cardiovascular problems, pulmonary disease, or those over the age of 75. These higher risk groups experience more frequent cardiac problems during and after surgery as well as greater blood loss. However, even if you are relatively healthy and free of cardiovascular problems, extending anesthesia time increases the risk of complications. 

Staged Bilateral Knee Replacement

A staged approach allows one knee to recover before the second knee undergoes a replacement. It requires a 3-5 day hospital stay for each of the two surgeries versus up to 10 days for a simultaneous operation. However, these surgeries may occur hours, days, or weeks apart—so the six to 10 total days can be spread apart.

You’ll have the same risk for other complications—such as blood clots—whether you undergo a simultaneous or staged approach.  

Know Your Risks

The the Agency of Healthcare Research and Quality (AHRQ) reports that those 65 or older who undergo a simultaneous bilateral procedure have about twice the likelihood of complications as patients 45 to 65 years old. Men showed a 50 percent greater risk for complications than women. The most common complications are pulmonary and neurological in nature. Another study found that a simultaneous procedure essentially doubles the risk of complications and triples the risk of death within 30 days for those above age 70.

While there may be some benefits associated with getting the job done all at once, especially when the pain is equally severe in both knees before surgery, it’s important to recognize that a simultaneous double knee replacement creates additional stress for the body. Rehab can be slower—it typically takes about twice as long—because it’s more difficult to bend, lift, and flex both knees at the same time. In the most basic terms, you don’t have a leg to stand on.

In addition, a simultaneous procedure requires additional assistance at home—typically a nurse and/or family members—because of the strain involved in relearning to use both knees. This emotional and physical support may be required for weeks. Lastly, having both knees done at once may result in some cost-savings, because you spend less time in the hospital (one stay instead of two). Medicare and most private insurers will provide coverage for the simultaneous or staged approach. Your surgeon will determine what approach is best, weighing the risks of each procedure and your age in the decision.

Despite the risks and challenges of undergoing a double knee replacement, both simultaneous and staged knee replacements offer a 95 percent success rate over 15 years.  If you think you might be a candidate for a double knee procedure, consult with your doctor and discuss your options.