Newswise — Orthopedic surgeons perform almost 700,000 knee replacements in the United States each year. The procedure has a high success rate, alleviating pain and restoring an active lifestyle. It’s fairly common for patients to have arthritis in both knees, and they often decide to have both of them replaced. The dilemma many people face is whether to have surgery on both sides at the same time, a procedure referred to as “bilateral knee replacement,” or two separate procedures.
Geoffrey Westrich, MD, research director of Adult Reconstruction and Joint Replacement at Hospital for Special Surgery (HSS), advises people to carefully weigh the pros and cons before making a decision. “Many people want to have a double knee replacement because they feel they can get it over with faster since there’s one surgery, one hospital stay and one course of rehabilitation,” he says. “The bilateral procedure enables patients to get back to their normal lives more quickly, and for the right patient, it’s a good option. However, double knee replacement is not for everyone, and people should be well-informed before making a decision.”
Studies show that bilateral knee replacement has a higher rate of complications, including cardiovascular problems and blood clots. Patients lose more blood, so they are more likely to need a blood transfusion. Rehabilitation is also much more demanding. Candidates must be in excellent physical condition, aside from the arthritis, with no underlying health problems, Dr. Westrich says.
“Not too long ago, people thought that if you had one knee replaced, the pain and rehab would be so taxing you wouldn’t want to come back for surgery on the other knee,” he says. “But nowadays, with advances in surgical techniques, anesthesia and pain management, the recovery for a single knee replacement at a high-volume joint replacement center is much easier and faster than it was in the past. In our experience, virtually every patient comes back for the second knee replacement.” Patients generally wait at least three months in between surgeries.
Patient Selection Important
Overall, the success rate is high for a same-day double knee replacement, but patient selection is important, according to Dr. Westrich. He says it should be out of the question for patients with a history of heart or lung problems, or any other serious medical condition. At HSS, bilateral knee replacements are not performed in individuals over 75 years old due to the greater risk of complications in older patients.
“Patients who meet the criteria need to know exactly what to expect so they can make an informed decision about same-day double knee replacement,” Dr. Westich says. “The recovery and rehabilitation after bilateral knee replacement are much more challenging because greater physical and emotional strain is placed on the body. The rehab is also much more difficult because patients can’t rely on a stable leg for support.”
Another consideration is where an individual will receive physical therapy. Bilateral knee replacement patients almost always spend time in a rehabilitation facility after surgery, while those who have a single knee replacement often go straight home from the hospital and receive physical therapy at home.
Whether having two separate knee replacements or both sides replaced simultaneously, the orthopedic surgeon should have a detailed discussion with the patient about what to expect.
Because of the special considerations involved in double knee replacement, Dr. Westrich says it’s especially important for patients to choose a highly experienced orthopedic surgeon who specializes in knee replacement.
Patients should also choose a hospital or specialty center that performs a high volume of joint replacements, such as Hospital for Special Surgery, he says. The entire staff will be accustomed to dealing with the needs of double knee replacement patients before, during and after the surgery.