Bilateral knee arthroplasty is the replacement of both knees during the same period of time. This procedure can be simultaneous, with both knees operated on during the same surgery, or staged, with separate surgeries performed on each knee a few days or weeks apart. Bilateral knee arthroplasty is performed on patients disabled by severe arthritis in both knees. While the bilateral procedure is longer and more complex than a single knee arthroplasty, the pain relief after surgery is much greater and the overall rehabilitation time is shorter.

There is some debate about whether the simultaneous procedure is preferable to the staged operations and also about whether bilateral arthroplasty is always more beneficial than two widely spaced operations.

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Advantages of the Simultaneous Bilateral Procedure

There are several important advantages to a bilateral total knee arthroplasty, including:

  • Single administration of anesthesia
  • Shorter hospital stay
  • Reduced costs
  • More efficient correction of bilateral bone deformities

The great majority of patients who have had the bilateral procedure say that they were pleased with the results and, if given the choice, would choose this method again. Once the immediate postsurgical pain abates, they experience relief in both knees. In addition, they only have to undergo one surgery and one period of rehabilitation.

Risks of Simultaneous Bilateral Procedure

While total knee arthroplasty is considered a safe operation, it carries the risks of any surgical procedure, including excessive bleeding, blood clots, infection and adverse reaction to medication or anesthesia. The rate of these complications is approximately the same for bilateral or singular operations. For some patients, early rehabilitation may be more difficult after the bilateral surgery since there is not an unaffected leg to use for support.

Bilateral total knee arthroplasty is not usually recommended for patients who are over 80 years of age or patients who have serious underlying medical conditions. In these situations, bilateral surgery may present a greater risk since it is a larger, more traumatic event than smaller, more widely spaced procedures. Patients in these categories are at greater risk of developing cardiopulmonary and neurological complications or of requiring blood transfusions.