Two knee replacements at once: the good and the bad.
So would you like one knee, 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. We discuss the merits of doing two knee replacements at once below. And we have included the stories of a few recent bilateral knee patients to help you decide if you want one lump… or two.
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 Consequences of this Trend
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.
Not All Good News
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.”
Ed and Pre-hab before Double TKA
I have met many bilateral knee replacement patients whose recoveries were highly successful, and who were very happy that they did two knees at once. Ed, who had bilateral TKA in the spring of 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 & The Mailbox
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. Mike 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 & a Fractured Tibia
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 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. Steve 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. He never looked back, very pleased that he went forward with his own double.
Betsy, Two Knees, One Knee Per Surgeon
Betsy reached 110º range of motion in two weeks with each of her two knee replacements. At the time of her surgery Betsy was 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.
Back to Sports and Activities
Betsy 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 was 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.
Her surgery was performed by Drs. Lederman and Kwartowitz who used ConforMIS knee hardware. 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.
Record Setter Ray (North Carolina)
In the spring of 2018 Ray Natili, an NCAA basketball official, went ahead with both knees at once… for a very specific reason. He had to be back on the courts, performing at the highest athletic level, within six (6) months. He would never have done it any other way as you can see in his interview below. This fall Ray will be the first NCAA basketball referee to return to his job on the courts after a bilateral knee replacement.
What About One Knee After the Other?
Plenty of patients do their knees one after another, thereby not putting all the pressure on themselves at once. In fact this is much more common that bilateral surgery even with the trends toward bilateral that we are observing. Jeff in Michigan did just that and completed a 5K within two months of his second TKA. From first TKA to 5K it was six (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. And for those who’s health is not as good or do not have enough support at home for a more demanding recovery it can be the best option.
Dave, a Scare, then a Fast Recovery
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
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 a lower risk of infection which is a knee patient’s greatest risk from knee surgery. Also note that surgeons use different tools on each knee and that you could 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. We know that recovery from skilled nursing facilities is highly variable. I know from personal experience with my patients how poor the results can be in these institutions. I advise that you avoid them if at all possible.
If you are planning on home care for your recovery, note that 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. If you do two knees at once and go home you will need a trusted friend, spouse, caretaker to help you for 7-10 days.
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 recover from a bilateral knee replacement. But many would say that it’s worth it.
Are You Considering Bilateral Knee Replacement?
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 or she can track your 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.
The X10 Meta-Blog
We call it a “Meta-Blog” because we step back and give you a broad perspective on all aspects of knee health, surgery and recovery.
In this one-of-a-kind blog we gather together great thinkers, doers, writers related to Knee Surgery, Recovery, Preparation, Care, Success and Failure. Meet physical therapists, coaches, surgeons, patients, and as many smart people as we can gather to create useful articles for you. Whether you have a surgery upcoming, in the rear-view mirror, or just want to take care of your knees to avoid surgery, you should find some value here. Executive Editor: PJ Ewing (firstname.lastname@example.org)