Patient Care : Bilateral Knee Replacement

Bilateral Simultaneous Knee Replacements

If you have severe damage and pain in both knees or hips but are otherwise in good health, you may be able to choose between replacing both joints during a single surgery (simultaneous replacement) or scheduling two separate operations several months apart (staged replacement). The decision requires careful discussion with your doctor and physical therapist. Benefits of a simultaneous approach are a single anesthesia, shorter total hospitalization, and one prolonged rehabilitation that lets you resume normal activities sooner than two shorter ones. You should also consider having simultaneous operations if the condition of your joints is so poor that replacing only one joint would still leave you unable to function during physical therapy, thereby slowing your recovery. In addition, to do well in rehabilitation after simultaneous surgery, you need enough arm strength to cope while you can’t stand on either leg.

Having two separate operations requires fewer blood transfusions, and some complications are less likely. In analyzing thousands of knee replacements, Mayo Clinic researchers found that patients who have simultaneous knee replacement are more than twice as likely to develop dangerous blood clots or die within 30 days as patients who have single-knee surgery, although such complications are rare. People over 80 and those with cardiovascular or lung disease are usually offered staged procedures. If you have any significant medical risks, you are probably better off having two separate operations.

Because you spend less time in the hospital, simultaneous joint replacement costs somewhat less than staged procedures. However, as long as both knee replacements are deemed medically necessary, Medicare and most private insurers cover either schedule.