Two Knee Replacements at Once

RECOVERY MATTERS – a BLOG about Knee Replacement Health

Two knee replacements at once: the good and the bad.

So would you like one knee, or two?

two knee replacements

One lump, or two.

It is called bilateral knee replacement. Two knees. At the same time. Usually it is performed by one surgeon; at times it is done simultaneously by two surgeons. And it is a massive trend in knee replacement nowadays.

Doctors are split on their opinions of this surgery.

Some orthopedic surgeons simply will not perform two knee replacements at once, preferring at least a three-month separation between surgeries. Many suggest that age, physical health and mindset play a role in the final outcome, and that recovery is more demanding for two knees vs. one. There is also evidence that younger patients have a harder time recovering in the short-term, only to do well over the long-term.

Other surgeons agree to perform double replacements knowing that it can be better for the patient to just get it done at once so they can get back to their lives more quickly. The problem is that with this seemingly irreversible trend toward “doubles”, patient results have suffered.

Lisa Alarcon, Director of Physical Therapy at Michigan VNA notes that “if your knees are bad enough so that one knee cannot really support all of your weight then go ahead and do them both.” She also suggests that for rehabilitation, bilateral surgery has it advantages in that “you cannot cheat” when you are doing your rehab exercises because both knees are in recovery. Patients with two knee replacements at once can do very well in rehab because of this balanced recovery. Of course there is double the danger of succumbing to scar tissue before you can get to a good range of motion. Lisa discusses the dangers of scar tissue here.

Trends in Bilateral Replacements

I recently took a look at a study on bilateral knee replacement surgery published by Hospital for Special Surgery, where much of the pioneering behind knee replacement was done. I was surprised at what I found.

The number of bilateral total knee replacements performed between 1999 and 2008 increased by 75%. In 1999 bilateral procedures accounted for 3.7% of all knee replacement operations. By 2008 they accounted for 6% of operations.

The average age for bilateral surgeries during that same time frame decreased by 2.5 years. However the rate of comorbidities (the presence of one or more additional disorders) increased measurably during this time frame. More complications and difficulties were seen for those with two knee replacements. Clouding matters further was the fact that obesity increased by 131% during this time frame. It is all related as the number one cause for knee replacement surgery is obesity.

Dr. Stavros Memtsoudis, the highly respected orthopedic surgeon who oversaw the study, said patients “should critically look at themselves and talk to their physicians about how their health status plays into the choice of surgery.”

I have met many bilateral knee replacement patients whose recoveries were successful, and who were very happy that they did two knees at once. Ed, who had bilateral TKA this spring (2014) said, “I found at least five people (friends) who had one knee done but never went back for the second one because the pain, in their judgment, was so bad.” Ed feels that the mental preparation is just as important as the physical preparation prior to TKA. Ed’s surgeon, Dr. Ward, was willing to preform a bilateral knee replacement in part because of Ed’s commitment and dedication to preparing himself for success. He knew Ed was going to work very hard before and after his surgery.

Mike was walking to the mailbox in about eight days, and picking weeds in the garden. He was back to work in a warehouse lifting 300 lb. boxes within three months of his bilateral surgery. He was athletic and in shape before he went ahead with his surgery, and he was 52 at the time of the operation, in late 2013. You can view a full interview with Mike here. Mike’s surgeon, Dr. Gibson, was very impressed with his progress as was his recovery team at the outpatient clinic where he finished his recuperation three weeks early. His “mailbox story is presented here.

Steve had complications in surgery (a fractured tibia!) which slowed his recovery from two knee replacements. He still achieved 127º and 135º range of motion on his knees after six weeks. His recovery in the spring of 2014 progressed at a steady pace once his leg healed. You are unlikely to see better numbers than these especially after such an episode. It was the single rehabilitation period that made up Steve’s mind for him. Before going ahead with two knee replacements at once he consulted with a friend who recovered well from her double. “If she could do it, then I could,” Steve said. He wanted to get it over with and really warmed up to the idea when his surgeon, Dr. Brian McCardel, had no qualms about performing both surgeries in one four hour time frame. Steve sorted out a recovery plan with the latest in rehab technology and he never looked back, very pleased that he went forward with his own double.

Betsy reached 110º range of motion in two weeks with each of her two knee replacements. Betsy is in her early 50’s. She is athletic, plays tennis and volleyball. Once she got going on her recovery in her own home, after a week in a skilled nursing facility, she really took off. Knee replacement has a major impact on everyone who goes through it. In Betsy’s case the implications are huge. Two knees are the difference between actually living, and just hobbling through life. As an entrepreneur she needed a quick recovery to get back to business. She has highly active kids and a great husband, Noel, who is naturally athletic. Without knees that can function even better than her original equipment, she will just not be able to accomplish what she wants to in work or play.

But regarding her recovery, “I basically am a big chicken,” claims Betsy. “I thought that once I went through all that pain for one knee replacement I would not want to go through it again.” She did not want to devote more than six months of her life to have both knees replaced one after the other. Betsy was also very concerned about the new Obama insurance (ACA) and the potential financial implications for her knee replacements. Her surgery was performed by Drs. Lederman and Kwartowitz who used ConforMIS knee hardware. At the time of this writing Betsy is glad that she went ahead with two knee replacements at once. She is back to tennis and living a very full life in Naples, Florida.

Plenty of patients do them one after another, not putting all the pressure on themselves at once. Jeff D. walked a 5K within two months of his second TKA. From first TKA to 5K it was 6 months. And if you ask Jeff he would say that he did it the right way. One knee did recover faster than the other, but he got there all the same in the end. Jeff’s recovery story is here.

SOMERS, NY — Dave had a scare on the day he got home from surgery. His heart rate was elevated and the nurse sent him right back to the hospital for three days. These are crucial days for recovery and have really compromised the recoveries of many patients. The first week of recovery is the most important and Dave found himself behind. With the help of his wife Carol Jean he caught up and was a full range of motion by four weeks post surgery. Dave and Carol Jean moved to Naples, FL; Dave now plays golf four days a week on some of the best golf courses in the nation.

Keep in Mind That…
It is common knowledge for those who do two knee replacements at once, that knees often recover each at a slightly different pace from the other. With double the surgery can come twice the risk of infection which is a surgeon and patient’s greatest fear with this surgery. But also understand that surgeons use different tools on each knee and that you can be infected in one knee but not the other. You will need more care at the very beginning after a double, which sometimes puts people in skilled nursing facilities after their surgery. That means not recovering in the comfort of your own home; generally not as good for a fast recovery. Adding to the difficulties, insurance companies do not double the number of weeks you have for home care with a bilateral surgery, rather you get twice the PT each day during your home care rehabilitation. Sub-optimal if you ask me.

Going Forward

Who knows if this trend toward bilateral knee replacement will continue. It may be that advances in rehabilitation will help doctors and patients succeed more often with two knee replacements at once. In the end the patient and physician must make this decision together, keeping in mind the patient’s overall health, financial, and emotional condition. It takes real work to recovery from a bilateral knee replacement. But many would say that it’s worth it.

If you are considering knee replacement (singular or bilateral) you owe it to yourself to explore the X10 Knee Recovery System™ for recovery from knee replacement in your home with the help of a Patient Coach and Physical Therapist. The X10 offers a pain-free recovery because its patented technology feels your knee and adjusts to you. And it shares your progress wirelessly with your surgeon so he/she can track you progress alongside you – virtually. To learn more click here: The X10 Knee Recovery System™.

Bilateral Knee Replacement: What do you think? I welcome your comments below.

PJ
@x10therapy

My names is PJ Ewing. I work with, talk to, learn from knee replacement patients every day as part of my work at X10. I am an X10 Patient Recovery Coach, helping patients who use the X10 Knee Recovery System in their homes for their recovery from knee replacement. I also hear the stories of their therapists and surgeons which help me write a better blog each day. To view other “Recovery Matters” blog entries, click here.

37 responses to “Two Knee Replacements at Once”

  1. Thank you for sharing such amazing article with us…found useful

  2. Amazing Content,,, Very Useful…
    Thank you for sharing this information with us…keep posting

  3. Debbie says:

    I had bilateral knee replacement done in March , went to rehab for a week and then 2 weeks home therapy, I was lucky to be able to finish10 weeks of rehab , I did really well but no one speaks of the depression one might experience, even when everything is going on schedule, has this happen to anyone else ?

    • Patty says:

      Yes, I am two weeks out from bilateral knee replacement. I have to have at least one good cry a day. I think the imidiate loss of independence, meds, and for me lack of sleep are just a few factors. I have four friends who had one knee done. They agreed that they became depressed and weepy. But, they also all assured me it did pass.

    • Patty says:

      Yes! I am so weepy and cry for no reason. I am two weeks out from Bilateral knee. I have four friends who experienced the same thing. They did one leg. I believe the meds and sudden lack of independence contributes to the depression. They all assured their emotions retuned to normal as they progressed.

    • Patricia says:

      Hi Debbie: I am facing a double. Did you ever get a reply to your post? How are you doing? Patricia in California

    • Dawn says:

      Yes !!!! I had by bilateral knee replacement 17 days ago and the depression that has hit me is very hard to deal with along with my recovery . It’s still very early in my recovery but at this point I wish I never would ha e done both at the same time I am sure 4-5 months from now I will be glad I did . Just having such a hard time with zero relief as one leg is doing so much better than the other

    • Becky says:

      Yes, and the extremely bad mood swings. I think we’re sometimes worse than the pain. Most of mine was in the first three weeks. Since I have done better. But finally at 5 weeks had my daughter take me to Walmart I rode the cart to just her out of the house. That was a major help. My bilateral knee replacement was May 30. I have my 7 week appointment tomorrow. Already out of therapy have 120 bend both knees and can straighten them all but maybe a fourth an inch to the table. Good luck. They way I felt mentally I would not have gone back and had the other knee done. It was a miserable feeling. I couldn’t shake.
      Becky

  4. Dr Ben says:

    Great post! But since this is a major operation, it is better to always discuss the operation and the post operation details with your surgeon and don’t be afraid to raise any concerns in order to address your hesitations the sooner.

  5. Thanks for sharing.This information found very useful.

  6. David says:

    I’m day 4 post-op bilateral TKR. I have been using a walker since day 2 unassisted. I can walk totally on my own for about 3 metres (10ft) and back. Climbed three stairs unassisted twice. Would have done more if they’d let me. Surgeon says it’s a remarkable recovery. Advice: don’t be shy on asking for pain meds. When you’re not in pain your body focuses on healing. Get a cryotherapy icing machine and use 3 times daily or more. Do the exercises. My life is changing by the moment. I was barely able to move prior to the surgery. Held off out of fear for to years. Hope this continues. Male, 58, 5’9″, 170#.

  7. Nancy Toscani says:

    I am soon to be 85 years old, have A fib, how can I have bilateral knee surgery, or can I?

  8. PJ Ewing says:

    The X10 machine handles two knee replacements at once as the chair easily switches between the left and right hand sides – it takes about 45 seconds to to that.

    X10 is available for Bilateral patients in Michigan and the Midwest, the Northeast and in Florida.

  9. Lauren says:

    My goodness. I am 32 years old the aggressive drugs used for my lupus situation created Osteoporosis having full avn in both knees and hips! I have good days kinda but bad days often walking with cane that barely relieves! I use to be very athletic but haven’t been over decade due to joint issues. I had one doctor want me to wait for even more severity in ability to walk and other doctor say he will do surgery to improve my quality to walk around early in my life than later! I am nervous and little skeptical now reading everyone different experience on bilateral knee surgery! Wish me the best. ..i know the expectancy rate on bilateral knee replacement but it’s the now in my life than suffering now until much later! God be with me

    • PJ Ewing says:

      Lauren: there are known factors that increase the risk of any knee replacement such as: high BMI, youth(!), ethnic background (African American’s build scar tissue quickly), smoking and some others. Be super conscious of your rehab program – it will likely be the most important thing you do. Questions please do not hesitate to email me at pj.ewing@x10therapy.com.

    • Phillip says:

      Hey Lauren I feel your pain I’m also 32 and scheduled to have bilateral knee replacement in ten days. This is such a damper to me as I have always had an active lifestyle with sports and also being told that knee replacement only good for like 20 years so not sure what I’m going to do when I’m 50.. I know that I will not be bound to a chair that’s for sure. I wish us both luck

    • Marie says:

      Hi
      I underwent simultaneous bilateral total hip replacement in february 2015. Four months later I also had simultaneous bilateral total knee replacement .
      The hips were by far easier than the knees in relation to recovery.
      Having both knees replaced together, at the same time, is really hard work but ultimately, worth it.

    • Annette Smith-Rich says:

      I wish u the very best!

  10. Kathy says:

    I am going to be 71 years old in March. Both of my knees are bone on bone. My surgeon told me that he could do both at once. I decided that with my age and condition that I should only get one done and get the next as soon as they would let me. I am scheduled for surgery on February 14, 2017. I am wondering if I should get them both at once but am afraid of the recovery time and infections. Could you give me any suggestions? Thank you!

  11. Pat Woods says:

    I just had bilateral knee,replacement in October and back up everything that Don said. I had no choice,about doing 2 knees at once. I had become reactive to injections. Some advice:
    1. – Prepare for the surgery. Take a physical inventory and if you haven’t exercised in a while, get into some kind of fitness program before committing to this surgery. I worked with a personal trainer for months before the surgery strength in my core, back arms an legs. If you cannot commit to that much work beforehand, you will not cope with the P/T required.
    2. – Do not rely on family for those first 10 days. You will be heavily medicated and virtually immobile without assistance. If you have no choice, I like Don’s idea of a,handicap room in a motel. I had the luxury of a skilled nursing facility and it was a lot easier than what others have gone through.
    3. – Be aware that your P/T will start as soon as you are concious after surgery. At the nursing center, it was 45 minutes,a session every day except Sunday. Once I was released, it was 90 minutes 3 times a week with additional exercises at home. You will be exhausted, and in pain – plan on it.
    4. Do buy cooling machines for for your knees. It will lessen your pain considerably. My insurance did not cover them. Take them with you to the hospital and they will have them on you knees before you even wake up.

    My progress? After 11 weeks I am back at work and walking without assistance. There is still some pain if I push myself too hard, but nothing that cannot be managed with ibupropherin. I am back working with my trainer and feeling better every day.

    Demographics: 64 year old woman 65 lbs overweight. Former couch potato.

    • PJ Ewing says:

      Pat – we cannot thank you enough for your highly useful comments!

    • Sharon Parker says:

      WOW! That is super-impressive! I am 53 and a (reluctant) couch potato, due to RA, OA and fibro. I used to hike and do athletic vinyasa flow yoga. Now I have a handicapped placard and can barely walk. In the past two weeks, I’ve gotten cortisone injections and Monovisc. I have no cartilage left on the inner side of both knees, with spurs. For years, various surgeons have said I am “too young” for replacement, but my quality of life has diminished to the point of work/home/work/home. My rheumie told me yesterday I may want to revisit TKR with a new doctor, as he’s had patients with less damage opt for surgery. I am greatly encouraged by your post!!!

  12. BILL POTTER says:

    I AM TRYING TO DECIDE ON 1 OR 2 KNEE
    REPLACEMENTS

  13. Jill says:

    Happy holidays. I am two weeks out of bilateral TKR and am happy with my progress. I have found that I have one knee I can almost ignore, as it is responding faster than the other, but right now I can give you an update? Had the surgery on Thursday morning and left the hospital for home Friday afternoon. Had my spouse on call 24/7 for the first week and a half. Exhausting! Now I have moved back into my beloved hammock, which I normally use for sleeping. I still use the walker at night, going to the bathroom, but otherwise am using a single cane. I am slow and deliberate with my moves, hoping that the slow moves now will accelerate recovery!

  14. Paula mendies says:

    I had bilateral knee replacement six weeks ago. I was fortunate enough to have two surgeons work together, one on each knee. I also was able to stay at a wonderful rehabilitation place and they pushed me and I worked hard to recover. It was a lot of work and a lot of nights crying, but I am glad I did it. I was driving and walking without anything within four weeks. I am returning to work within two months. Best decision ever.

  15. Hi my name is Montana I had both knees done in Feb I wait tables 6 shifts in 4 days I am 61 is it normal to still be sore and stiff and tired all the time. When can I expect to be back 100 percent?

  16. Don A says:

    Have just passed the three week mark for my bilateral knee replacement. Decided to do both to cut my rehabilitation time and time away from work in half. Avoided it having the surgery done for seven years but the quality of your life gets to the point where the surgery chooses you as opposed to the other way around.

    Several suggestions. In all the pre-surgery preparation and class no one told the caregivers how intense it might be, particularly the first week after coming home from the hospital. I would suggest you assess your situation and living conditions to determine whether or not you need to look at some type of skilled nursing care when you get out of the hospital. I had planned to go to a skilled nursing facility but my insurance company, Cigna only approved two days in the hospital. My operation was at 1:30 pm or so and I got back to the room just before 8:00 pm on a Thursday night. Conveniently, Cigna, my insurance company was not available on Friday and I had leave rhe hospital in mid-afternoon that Saturday, less than 48 hours. You are coming down off the anesthesia and having skilled caregivers shifting to family members to will have to take those roles. In my case my wife was able to be at home until that Wednesday then had to return to work. Not sure what people do who have a house with lots of steps / different levels or do not have family members or friends who can help did you are virtually incapacitated for the first couple of days. Getting in and out of bed, normal functions like going to the bathroom, taking a shower, putting on the TED hose, putting on the immobilizers, changing the ice in the BREG coolers that help ice down your knees initially require assistance.

    We lost power the following weekend after the surgery and had to check in to a hotel. We found out that a handicap room at say any of the major hotel chains are set up well for a functional and conducive environment. It has handicapped restrooms and shower facilities where you can sit and bars so you can maneuver and of course an ice machine where you can get ice for the BREG equipment. Having two queen sized beds allowed my wife to get as much sleep as she could given the circumstances. If we had know this, we might have gone to the hotel since CIGNA was MIA in approving any post surgery skilled care. Just some siggesrions which I hope will be helpful to anyone who decides to get both knees done.

  17. ASR says:

    I had BLKR surgery on May 2 , 2016 . I was expecting knee pain , but , I lost a lot of blood and had two transfusions . I’m still weak after 7 weeks , have major sleep issues , stomach upsets from the drugs . I’ve found it to be a slow recovery . However , my knees are doing very well ! I just wasn’t prepared for all the other side effects . I’m 73 and in good health .

  18. Larry Blackman says:

    i am a 65 year old male who had TKR bilateral on 2/7/16. It has been almost 6 weeks and I will return to work on Monday. So far I have had no complications. I think the main thing that helped me to decide to have both done at once was the research that I did in advance. Results were all over the board from having to have both replaced due to poor surgeon choice to uneventful full recovery. This helped me to prepare mentally for the worst and to hope for the best. I am 6’4″ tall and weighed in at 290 lbs at the time of my surgery. I stayed in the surgery hospital for 3 days which I have very recollection of and then transferred to an inpatient rehab facility for 10 days. During this time I was very weak and my daily rehab sessions wore me out. I did little moe but lay in the bed with CRM machine approximately 4 hours per day. I was able to go home on a walker and resume outpatient rehab for 12 sessions over a period of 3 weeks. I was able to ditch the walker within a week and a half of returning home. Used a cane for a week or so and began walking unassisted.

    5 weeks after surgery went to see my surgeon and he released me to return to work. I will return to work in 2 days on 4/18/16. My knees feel a little stiff after sitting and when I get out of bed. It is uncomfortable to stand for a short period of time or walk a short distance. I also have use my arms to assist in getting up from a sitting position. From all my research this is pretty normal for 6 weeks out. All will improve with time but make no mistake this is a major surgical procedure and I expect it to take a number of months to get to some feeling of normal. From what I’m finding out it may be 6 to12months. However I can tell you the pain was not even half of what I expected and I have had no hip or back pain that I was having before the surgery. Also I don’t want to leave out all the praying that I did in regard to selecting the right surgeon and for a quick recovery. Also having a prayer warrior support group lifting me up. I hope this may help someone considering this procedure to help improve the quality of their life.

  19. Cindy Mendoza says:

    I am going to have a bilateral knee replacement. I’m 60 years old . I am really looking forward to being able to walk and not be in pain, as I am now.

    • PJ Ewing says:

      Cindy – how did you do? – it is about 10 months since your surgery.

    • Katherine Hunter says:

      I had bilateral knee replacements on. May 23, 2016
      best choice I have ever made. Sixty year old female mail carrier. My Surgeon, Dr. Merritt, is so awesome. I was in pain for one day, the day after surgery. And for 5 years before which I could take no more. Almost in a wheel chair. I am in very little pain now and recovery has been mostly done on my own. No therapy by someone’s error for two months. Not a very happy camper but I made it and i’d do it again in a second. Lot’s of prayers by family and friends. Thank you all!

  20. Mary Jackson says:

    I am going to ask my doctor on Friday Jan,29th if I can get both of my knees done at the same time I am 57

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