Overview of Double Knee Replacement (Bilateral)

Double Knee Replacement Surgery

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Bilateral knee replacement surgery means that both knees are replaced. Patients who have severe knee arthritis in both knees may be good candidates to undergo bilateral total knee replacement. In general, there are two types of bilateral knee replacement surgery:

  • Simultaneous Bilateral Knee Replacement
    A simultaneous procedure means that both knees are replaced at the same surgery, in one day.
  • Staged Bilateral Knee Replacement
    A staged procedure means that the knees are both replaced, but not on the same day. The second surgery may be performed as early as several days after the initial surgery, or several weeks or months later.

    Who should consider bilateral knee replacement?

    Patients who have severe knee arthritis in both knees may be candidates for bilateral knee replacement surgery. The same criteria used to determine if a single knee requires replacement are used to determine if both knees should be done.

    What are the risks of a simultaneous bilateral knee replacement?

    There are concerns about performing a simultaneous knee replacement because it is a longer surgery and is more demanding on the body. Because of this, patients who have cardiovascular problems, pulmonary disease, or are over the age of 80 are often advised against a simultaneous knee replacement procedure.

    Studies have shown patients undergoing simultaneous knee replacement have a slightly higher risk of cardiac events and needing blood transfusion. Overall, the risk of severe complications such as infection, blood clots, pulmonary embolism or death is about the same for both simultaneous and bilateral procedures.

    Another disadvantage of the simultaneous knee replacement is that the early rehabilitation can be more difficult as patients do not have a "good leg" to work with.

    What are the benefits of a bilateral knee replacement?

    The benefit of simultaneous knee replacement is that both problems are taken care of at one time.

    The overall rehabilitation is a shorter time, and there is only one hospitalization. Patients also only require one anesthesia.

    Having only one surgery and recovery period may be preferred when scheduling time away from work, either for you or for your spouse or other support person who will be needed after surgery. Some people may need a stay at a rehabilitation center and this would also be a consideration. Some programs recommend boarding pets after surgery, and with only one recovery period it would mean less stress in separation from your pet.

    The costs for co-pays on insurance or out-of-pocket expenses may be lower overall with one surgical stay, one course of rehabilitation and physical therapy, and one round of post-surgical anticoagulation and pain medications.

    Is having a bilateral knee replacement my decision to make?

    Yes and no. Patients who are appropriate candidates for a simultaneous knee replacement can decide if they want both surgeries at the same time. However, your doctor may recommend against a simultaneous procedure if you have medical conditions that may place you in a higher risk category.

    Can partial knee replacement be done as a bilateral procedure?

    Yes. The same criteria are used to determine if patients who require bilateral partial knee replacement are appropriate to undergo this procedure as a simultaneous surgery.


    Bullock, DP, et al. "Comparison of Simultaneous Bilateral with Unilateral Total Knee Arthroplasty in Terms of Perioperative Complications" J. Bone Joint Surg. Am., Oct 2003; 85: 1981 - 1986.

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