My father is going to have both his arthritic knees replaced at the same time. He’ll spend about six weeks in transitional care and then go home with help from us. How do they do this operation? Is it one knee at a time or both at the same time?

With today’s improved anesthesia and postoperative care, patients have the option of bilateral total knee replacement (TKR) at the same time. This can be done by one surgical team doing both knees (first one, then the other) in the same operation. Or there can be two surgical teams working on both knees at the same time.

An alternative approach is to have a staged bilateral procedure. Staged bilateral refers to having both knees replaced. But they are done one at a time with a certain time interval (weeks to months) between procedures.

However it’s done, it has been suggested by many researchers based on results of studies that bilateral knee replacements are best done in high-volume hospitals by an experienced surgeon. Usually such facilities also have adequate intensive care units to care for patients who need close monitoring.

Each surgeon has his or her own techniques and postoperative management measures. Steps can be taken during and after surgery to prevent complications. For example, the surgeon tries to avoid making too large of a hole in the shaft of the bone to insert the implant.

Improved surgical techniques are helping to reduce the number of fat emboli that cause postoperative problems. When the bone is cut open, a glob of fat from inside the bone marrow can enter the blood stream. The embolism can travel to the heart or brain causing serious problems such as death, heart attack, or stroke. Suctioning of the hole where the implant will go helps cut down on the number of fat emboli that occur.

Newer techniques to minimize blood loss, reduce stress on the heart and lungs, and prevent other complications have made this kind of surgery possible.