Total knee replacement (TKR) is a surgical procedure that replaces damaged knee joint surfaces with artificial components to alleviate severe pain and restore function. It is commonly performed for individuals with pain and limited mobility, often due to arthritis. This article explores the possibility of undergoing TKR on both knees concurrently.
Simultaneous vs. Staged Knee Replacement
Simultaneous bilateral total knee replacement involves replacing both knees in a single surgical session under one anesthesia. In this procedure, damaged joint portions are replaced with prosthetic components made of metal, plastic, or ceramic. This differs from a “staged” bilateral knee replacement, where procedures are performed separately, often months apart. A staged approach requires two hospital stays and two rehabilitation periods, allowing the first knee to recover before the second surgery.
Factors Influencing the Decision
Simultaneous bilateral knee replacement offers advantages like a single hospitalization and rehabilitation period, potentially leading to a quicker overall return to daily activities. This approach can also be more cost-effective by reducing expenses associated with multiple hospital stays.
However, simultaneous surgery involves a longer operation, often around three hours, and increased time under anesthesia compared to a single knee replacement. There is also a greater potential for increased blood loss; some studies indicate around 40% of patients may require a blood transfusion, which is less common in single knee replacements.
Recovering from both knees simultaneously can be physically and emotionally demanding, leading to a more challenging and initially more painful rehabilitation experience. Complications like blood clots and cardiovascular problems may also present a higher risk with simultaneous procedures compared to single or staged replacements.
The Recovery Journey
Recovery following simultaneous knee replacement is more demanding than after a single knee replacement. Patients begin physical therapy within hours of surgery, focusing on standing and walking with assistance. Rehabilitation intensity is heightened because both knees require attention, making it challenging to rely on a stable leg for support.
This often necessitates an inpatient rehabilitation stay immediately after hospital discharge, where patients receive intensive therapy, sometimes three hours a day, five days a week. Regaining mobility in both knees concurrently requires diligent adherence to a comprehensive rehabilitation plan.
Patients work on increasing strength, range of motion, and balance through exercises like step-ups, leg balances, and knee bends. While overall recovery time might be reduced compared to two separate surgeries, the initial post-operative period can be more painful.
Full recovery, including regaining strength and mobility, can take anywhere from three to twelve months. Patients are encouraged to increase physical activity gradually and may need assistance at home for several weeks.
Who is an Ideal Candidate?
Identifying appropriate candidates for simultaneous bilateral total knee replacement is important due to the procedure’s increased demands. Ideal candidates are typically younger, healthier individuals with no underlying medical conditions like severe heart, lung, or kidney disease. Patients with a body mass index (BMI) over 40 are generally not considered suitable due to increased complication risks. Good bone density is also a factor.
A strong support system at home is often necessary, as patients require significant assistance during initial recovery. Candidates should also be highly motivated and psychologically prepared for the intensive rehabilitation process.
The decision for simultaneous surgery is individualized, requiring thorough medical evaluation by an orthopedic surgeon to determine if potential advantages outweigh the increased demands and considerations.