Is a second knee replacement worse than the first?

There is a huge difference between the second knee replacement on the same knee, also known as a total knee revision surgery, and the second knee replacement on the other knee.

As a physical therapist, I am fortunate to hear all the stories… the good ones and the challenging ones. Now, I get to share those stories and experiences with you.

1. How difficult is a second knee replacement?

Many of my patients will say the second knee replacement is easier than the first primarily because they are better prepared.

Before the first knee replacement patients are often anxious and have no idea what to expect. They have asked as many questions as possible, but they often don’t even know what questions to ask until they are in a situation.

Even when the first knee replacement was challenging, the second may be easier because you know you survived the first.

2. Is a second knee replacement as painful as the first?

Pain science and modern research suggest fear and anxiety are magnifiers of the pain experience. We believe pain is highly contextual and because of this, the second knee replacement is often less painful simply because the patient has been down this road already.

In cases where the second knee replacement is more painful, some patients report knowing what to expect and feeling better in control which provides a sense of calmness despite the increased pain.

Pain Medication

During the first total knee replacement surgery, patients and surgeons are often trying to predict pain medication dosage and response. Everyone is different and because of this, it is difficult to determine which pain medication will be best. 

I have found that some patients respond better to one medication versus another so the first knee replacement allows for this discovery process to happen which means that during the second knee replacement surgery you have figured out which medication is best for you.

Non-Pharmaceutical Pain Management

During the second knee replacement recovery process many patients also better understand how to manage their pain with ice, compression, and elevation. 

Patients did the experimentation during the first procedure and they often have the equipment ready for the second surgery. Ice machines and wedge pillows help reduce swelling and pain for many patients.

3. Knee Replacement Revision

A second total knee replacement surgery may be a revision of the original knee replacement or a new knee replacement on a knee that has never had one.

Knee Replacement Revision Surgery

In the case of a total knee replacement revision surgery, it may be more challenging due to the reason for the revision and the condition of the previous knee replacement.

In my clinic, I have worked with patients that needed a revision knee replacement due to the failure of the components or infection. I have also had patients who were allergic to the material. 

While a revision surgery may be more complex than an original knee replacement, there are surgeons who specialize in this type of procedure. Locally, Dr. Richard L. Davis II, MD is one such surgeon. In this 35-second video he explains what a total knee replacement revision involves. 

4. Is a Bilateral Knee Replacement on the Same Day Better

When a patient will need both the left and the right knee replaced, a common question is if having a simultaneous bilateral knee replacement is better than two separate total knee replacement surgeries on two different days.

Simultaneous Bilateral Knee Replacement on the Same Day

Pros:

• Decreased hospitalization
• Decreased exposure to hospital-born infection
• Decreased total anesthesia
• Decreased total time off work
• Decreased total time needing help around the house during recovery

Cons:

• Increased complexity
• Increased physiologic demand on the body
• Increased blood loss
• Increased time under anesthesia
• Increased dependence on assistance

* Research suggests even in healthy individuals, spacing out your total knee replacement surgeries by 6 or more weeks may be safer and result in a better long-term outcome than performing a same-day bilateral total knee replacement procedure. Link

5. Does Age Affect the Outcome of a Second Knee Replacement?

Being older is always a factor. While there are people who may be healthier and more fit in their 60’s than they were in their 50’s, being 10 years old may still influence your recovery.

I work with many patients in my clinic who had a total knee replacement in their 50’s then waited more than a decade to have a second knee replacement.

Some of them are surprised at how much more challenging the second knee replacement recovery is until I remind them that they are 10+ years older.

Summary and Key Points to Consider:

✔️ Every knee replacement is different.

✔️ Every person having a total knee replacement is different.

✔️ It is impossible to predict how well or challenging a recovery may be.

✔️ Do your best to prepare.

✔️ Find your support system, hope for the best, and plan for the worst.

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