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Weighing the Risks of Having One or Both Knees Replaced

Are you the kind of person who tests the water one foot at a time, or are you more likely to jump in with both feet? This is the kind of decision people who need both knee joints replaced have to make. They can choose to do one knee at a time or both at the same time.

Before making a decision like this, a little more information is helpful. What are the risks and problems with each choice? How often do patients die after having knee replacements? Are you more or less likely to die after a single or double (bilateral) knee replacement?

Doctors at Dartmouth Medical Center took a look at these questions. They reviewed the records of two groups of total knee patients. One group had a single joint replacement. The other group had both knees replaced at the same time. They found no difference between the two groups in terms of blood clots, internal bleeding, or knee infections.

The only real difference was in the number of patients who had a heart attack after the operation. In this study, patients over the age of 70 treated with bilateral knee replacements had a greater risk of heart attack. The bilateral group also needed more blood transfusions. Very few patients died in either group. The risk of death is no greater for patients having a single or double knee replacement than someone the same age without surgery.

The authors think older patients are willing to accept more risk by having a bilateral procedure. They do this to reduce the amount of time in the hospital. The time in recovery afterwards is also less. A bilateral approach is still safe with few problems for most patients.

References: Daniel P. Bullock, BA, et al. Comparison of Simultaneous Bilateral with Unilateral Total Knee Arthroplasty in Terms of Perioperative Complications. In The Journal of Bone and Joint Surgery. October 2003. Vol. 85-A. No. 10. Pp. 1981-1986.

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