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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.
