3 Pros & Cons of Bilateral Knee Replacement

Having a bilateral knee replacement on the same day vs different days depends largely on your surgeon’s assessment of your condition and current clinical research.

A 2020 study suggested that patients receiving a same day bilateral knee replacement were not more likely to have a 90-day hospital readmission when compared to patients who received a single total knee replacement. [1]

Also a 2018 article suggests no increases in complications or hospital length of stay when recieving same day bilateral total knee replacement if the patient is a good candidate for the procedure. [2]

So the real question is, what makes someone a good candidate for a same day bilateral knee replacement and why would someone prefer to have time between knee surgeries?

Who is a Good Candidate for Same Day Bilateral Knee Replacement

Some of the main criteria include:

• Age (Younger is better)
• Low Risk of Infection (No immunocompromising conditions)
• Normal Range BMI
• Presurgical Activity Level
• High Presurgical Functional Level
• Strong Support System at Home

3 Pros of Bilateral Knee Replacement on the Same Day

1. Decreased Risk of Infection

Each surgery brings its own risk of injection. In a 2001 study, 6,120 total knee replacement surgeries resulted in 116 infections. [3]

Since having both knee replacements done in the same session, the total duration of exposure to possible bacteria may be reduce on a relative basis.

2. Quicker Overall Recovery

By having both knees replaced at once the recovery time isn’t doubled. In most cases the recovery time remains around 12 weeks.

When having one knee replaced then several weeks or months later having the second knee replacement, many patients will double the total time they are recovering from surgery.

For more information about recovery click here.

3. Decreased Cost

When patients undergo a bilateral knee replacement they often have less financial cost in out of pocket expense, but there is also the cost of having help at home.

A spouse might take time off of work to help during the first week of recovery. You might need to arrange meals or pay for extra services like laundry and lawn care. If you can compression two surgeries into one, you can usually reduce the overall cost of assistance.

Cons of Bilateral Knee Replacement on the Same Day

1. Increased Physiologic Demand

Bilateral knee replacement often means longer surgical time, more blood loss in a single session, and longer time under anesthesia.

It may also mean a higher toll on your immune system.

2. You Might Not Need The Second Procedure

Once the first total knee replacement is complete and you actively participate in physical therapy you might find that you don’t need the second knee replacement.

In my clinic I have worked with a handful of patients who responded so positively to the first procedure and physical therapy that the pain resolved in the non-surgical knee and those patients decided to wait before having the second knee surgery.

3. Return to Work Slower

Having one knee replacement might allow you to return to driving and return to work more quickly than having both done at the same time.

Bilateral knee replacement might put more stress and financial pressure on you if you have a job that requires prolonged periods of standing, walking, or squatting and you find that you are not recovering as quickly as expected. 

Facebook Comments on the Topic

Facebook Post & Associated Comments:

Original Post: “I’ve just found out I will need a TKR on my right knee in August. I will eventually need the left one. Pros and cons of doing both at the same time?”

Replies:

“I did bilateral and you have to be in semi good health or surgeon won’t do it. Con is the beginning is very hard and you do not have a good leg to stand on. Pro is you are done. No pre approvals for next surgery or making accommodations. Up to the individual but not for the meek.”

Poster: “were you able to get all your range of motion and do rehab pretty easily? Or if you had to do it over, would you opt for one at a time? So happy to hear you’re doing better.”

Commenter: “I rented an automatic stand up chair from a drug surgery place. My bedroom is upstairs so I had to stay downstairs to sleep in the chair and have a toilet accommodation. My range of motion was fine but I lost blood and my blood pressure dropped so I was dizzy initially and had difficulty standing the first two days. Had at home PT for two weeks. My boyfriend stayed with me and drove me to out patient therapy and cooked etc.You would need help with bilateral. Two to three weeks are very difficult but now at eight weeks I feel good and I am driving and bending. My range of motion is excellent. Can walk without cane. You need to be patient. I had a couple days of panic and crying in the beginning. Best of luck no matter what you decide.”

Poster: “I am glad it is all over with. I would not want to go back and if you wait too long for the second then you can have other issues like back or hip pain since you favor one side over the other I am happy but my left took longer than my right. It was probably worst to begin with. I was bone on bone with both knees. My advice would be do the pre exercises especially to build up your thighs and arms to lift yourself.”

Commenter: “oh thanks for the details. The standup chair is probably not an option for me due to lack of room in my house. So that is something to consider. I actually haven’t talked to my surgeon about both, yet. He may tell me no.”

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References:

1. Hernandez NM, Ryan SP, Wu CJ, Hinton ZW, Wellman SS, Bolognesi MP, Seyler TM. Same-day Bilateral Total Knee Arthroplasty Did Not Increase 90-day Hospital Returns. J Orthop Surg (Hong Kong). 2020 Jan-Apr;28(2):2309499020918170. doi: 10.1177/2309499020918170. PMID: 32383397.

2. Davidson IU, Brigati DP, Faour M, UdoInyang IJ, Ibrahim M, Murray TG. Same-Day Bilateral Total Knee Arthroplasty Candidacy Criteria Decrease Length of Stay and Facility Discharge. Orthopedics. 2018 Sep 1;41(5):293-298. doi: 10.3928/01477447-20180815-02. Epub 2018 Aug 21. PMID: 30125039.

3. Peersman G, Laskin R, Davis J, Peterson M. Infection in total knee replacement: a retrospective review of 6489 total knee replacements. Clin Orthop Relat Res. 2001 Nov;(392):15-23. PMID: 11716377.