Man Sitting on Bed Before Double Knee Operation

If you need both knees replaced, is it better to have the operations at the same time or one after the other? YKC’s Jim Newman explains.

Here’s a question for you. If you needed a total knee replacement on both knees, would you imagine the better option would be to get both knees operated on at the same time? Or might the better choice be to recover from the first knee replacement before embarking upon the second?

On the face of it, a double (bilateral) knee replacement seems to make sense. There’s just one period of being out of action, one trip to hospital, one period of time off work and one bout of post-op pain.

Where bilateral total replacements are performed (and they tend not to happen very often) the above factors are often a big part of the reason they happen at all.

But there’s an issue, and it was one that was thrown into sharp focus recently by some research that discovered bilateral knee replacements may increase the risk of complications including pulmonary embolism, strokes, blood loss and anaemia.

Total knee replacements tend to happen in older patients (younger patients are often better suited to partial knee replacements) and a bilateral knee replacement is usually a longer procedure than a single, with more anaesthetic required, greater blood loss, more time in tourniquet and so on.

The surgeon’s role is all about weighing risk and, in general terms, a bigger operation in an older patient tends to fall on the wrong side of that risk calculus.

> Discover more about partial or total knee replacements


Can bilateral knee replacements be safe?

Yes. We do them for partial knee replacements quite regularly because a partial is a much smaller operation than a total, but also because partial replacements may be suitable for patients who are younger and healthier (which also reduces risk).

Even in the case of total knee replacements, though, a bilateral knee replacement where both knees are treated simultaneously (i.e. with two surgeons taking a knee each) also seems to keep the risk factors as low as for an operation on a single knee. My colleague Nick London has written a paper on this very topic.

Yet the reality is that this tends not to happen very often. It’s far more common for bilaterals to happen concurrently (that is, one knee immediately after the other) than simultaneously. That would appear to be the key factor that sees risk increasing.

And that’s why knee surgeons are increasingly unlikely to recommend bilateral total knee replacements.

If you’re exploring your private knee replacement options, please contact us, or phone us on 03453 052 579.

> Find out more about Jim Newman
> Questions about your knee surgery?
> Discover more about partial or total knee replacements

James Newman

James Newman

Private appointments weekly at Spire Methley Park Hospital

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