Is Bilateral Knee Replacement Right for You?

Having one knee replaced is a big decision on its own. When both knees need it, the question becomes whether one trip to the operating room is better than two. Some research shows that replacing both knees at the same time is cost-effective and about as safe as replacing a single knee, while other large studies conclude that doing both at once carries a higher risk of complications. If you're otherwise healthy, it's a conversation worth having with your doctor and physical therapist.

The Case for Doing Both at Once

There are real advantages to replacing both joints in a single procedure: you go under anesthesia only once, spend fewer days in the hospital, and go through just one rehab (albeit a longer one) rather than two separate ones, which can let you get back to normal activities sooner. Because you spend less time in the hospital overall with a simultaneous replacement, it also tends to be somewhat less costly, and when replacing both joints is medically necessary, Medicare and most private insurers typically cover this approach. It can also make sense if your joints are in bad enough shape that replacing only one would still leave you unable to fully participate in physical therapy, which would slow your recovery.

The Case for Staging Them Separately

Mayo Clinic researchers who reviewed a large number of knee replacement procedures found that people who have both knees replaced at the same time are more likely to develop dangerous blood clots or die within a month than those who have a single knee replaced, although these complications are rare overall. Simultaneous bilateral knee replacement requires more time in surgery and heavier doses of anesthesia, which raises the risk of complications, and it isn't generally recommended for people with heart or lung conditions, who may face a higher chance of heart problems or excessive blood loss during and after surgery. If you carry any significant medical risks, two separate operations, done several months apart, may be the safer route.

What Rehab Looks Like Either Way

Whether you have one knee replaced or two, your rehab program will be a major factor in how well the surgery works out. Several times a day you'll perform exercises your physical therapist recommends to restore movement in the knee and strengthen the surrounding muscles. Recovery from a bilateral replacement can be slower, since it's harder to use both knees at once, and many people who go through simultaneous surgery need help at home while they recover. Most physical therapy programs run 6 to 12 weeks and typically include a walking plan along with knee-strengthening exercises that gradually build up your ability to manage daily tasks like using stairs. Ask your doctor and physical therapist how soon you can expect to return to specific activities such as driving, work, or sports, and what it will take to get there.