Total Knee Replacements: One at a Time, or Both Together?

If you have arthritis in both knees and need both joints replaced, should you have them done one at a time or both at the same time? This debate goes on in medical circles. Some doctors recommend both at the same time because it saves money and time. Others do only one at a time for safety and because of the increased rate of problems.

A doctor from the University of Tennessee reviewed studies done so far on this issue. In this article he presents the reported advantages and disadvantages of having both knees done at the same time (bilateral replacement). On the positive side:

  • Patients are usually very happy with the results.
  • Patients generally get back to full function faster.
  • There are fewer total days in the hospital.
  • Fewer days in the hospital means lower costs.

    The downside of bilateral knee joint replacement:

  • Many studies show an increase in problems during and after the operation.
  • Complications are serious, such as lung blood clots and heart attacks.
  • Patients with a history of heart disease are at increased risk for heart and lung problems.
  • Patients tend to be more confused after bilateral knee replacement.
  • Gastrointestinal problems are more common.
  • Complications cause costs to be much higher because of blood loss, the need for intensive care, and longer hospital stays.
  • There are more cases of death after having both knees done at once, compared to having a single knee replacement.

    The doctor concludes that each patient must be evaluated one at a time when making the decision to do both knees at once. Reports seem to suggest this operation should be limited to patients younger than 70. They should be free of heart disease. Patient selection is the key to success.