**By David Kieras, MD, FAAOS
If someone you know has severe arthritis in both knees that greatly reduces their quality of life, they may be a candidate for bilateral simultaneous knee replacement surgery, where both joints are simultaneously operated on in one surgical procedure.
Although not an option for everyone, this approach is enticing to many people who dread the idea of recovering from two separate surgeries, which delays recovery and a return to normal activities for several months, if not years.
Bilateral ‘staged’ knee replacement – one knee surgery followed by another – is not uncommon. However, bilateral simultaneous knee replacement is more advanced and uncommon due to the special expertise and team coordination required.
It can be beneficial for people who have limited time off from work for rehabilitation and need to return to a more normal lifestyle as quickly as possible.
Ideal candidates for bilateral knee replacement are reasonably physically fit, in good overall health, have any chronic conditions under good control and are younger than 80 years old. They also need to be motivated to go through aggressive physical therapy and rehabilitation.
The main advantages of a simultaneous procedure are that there is a lower infection rate associated with a single surgical event and it involves receiving only one episode of anesthesia. The surgery typically takes only about 90 minutes, which is advantageous since longer anesthesia times have been shown to be associated with greater risk for infection, blood clots, etc. In addition, patients only experience a single recovery and rehab period, rather than two.
Having both knees done at once may also result in some overall cost savings since patients only have one hospital stay. Medicare and most private insurers cover the simultaneous approach.
Another advantage, at least for people who choose to have it done at Virginia Mason, is that the size and scope of our team allows patients to benefit from the one-stop-shop design of our program, where everything from basic to high-level care is provided by seasoned orthopedic specialists in the community close to where people live.
However, it’s also important to recognize that bilateral simultaneous knee replacement surgery creates additional stress on the body. Your medical condition preoperatively is essential in determining the appropriateness and safety of this approach. A pre-surgery assessment by the surgical team, and any necessary medical specialists, will help patients decide.
Despite the risks and challenges, which are inherent in most surgical procedures, bilateral knee replacement offers a 95 to 98 percent success rate over 15 years.
Rehabilitation: Getting back on your feet
Our goal at Virginia Mason is to get patients up and moving as soon as possible after surgery. We try to control pain aggressively with nerve blocks, special injections around the new knees and oral pain medication. Newer techniques allow the placement of a temporary, indwelling catheter, which allows continuous pain block up to three days after surgery without significant compromise of strength – the ideal time period when pain would otherwise be at its height.
Rehab is somewhat more challenging initially because patients have to recover strength and range of motion on both sides to support them through their gait. But, compared to a knee that is already compromised by arthritis – as in a single knee arthroplasty – each new knee typically responds properly and improves with time – as opposed to gradual worsening in an arthritic knee while the new knee recovers. In fact, the residual arthritis in the opposite knee can permanently hamper recovery due to pain, swelling and dysfunction over time. As a result, transitioning people to walk is initially more challenging. However, after a week or two, bilateral knee patients typically outpace staged knee replacement patients as rehab progresses.
Home team advantage
In our program we want to get people home as soon as possible. As a result, we emphasize the importance of patients establishing a strong support system in advance to help with daily living tasks.
The challenge of recovery from bilateral simultaneous knee replacement takes a team approach. Patients can’t do it by themselves, particularly in the first few weeks, yet most can do far better than they imagine. So, we try to help them assemble their team – typically an interested family member – for a successful recovery.
A version of this story previously appeared in LocalHealthGuide/Seattle.
David Keiras, MD, FAAOS is a board certified orthopedic surgeon practicing at Virginia Mason Federal Way Medical Center. Virginia Mason is celebrating how everyday people come back from injury with the “Announce Your Comeback” campaign. Join the conversation on Facebook (Facebook.com/vmcares) and follow us on Twitter (@VirginiaMason).