Should I have both of my knees replaced at once, or should I have separate surgeries?

DEAR DOCTOR K:

I have severe osteoarthritis in both knees. Should I have both knees replaced at one time, or separately?

DEAR READER:

A patient of mine who was a newlywed once said to me: “We want three kids. Some days, I want them each separated by a year or two. Other days, I want triplets.”

You may have a similar dilemma. Knee replacement is a major operation and requires a hospital stay. During the procedure, the surgeon removes damaged sections of your shin bone and thigh bone. He or she carefully cuts the bone to precisely fit the shape of the replacement implants, then attaches the artificial joint at the knee.

Knee replacement also requires a rigorous program of physical therapy and rehabilitation after surgery. It’s just plain hard work. You need to be ready for that, as well.

Should you consider having both knees replaced during a single surgery (simultaneous replacement)? If you are in good health, it’s worth talking to your doctor about replacing both knees at once.

There are several benefits to simultaneous replacement. These include going under anesthesia only once and fewer total days in the hospital. You’ll also have only one period of rehabilitation, although it will be longer than the period that follows surgery on a single knee. This will allow you to resume normal activities sooner than two separate surgeries.

Replacing both knees at once is also a good option if both of your knee joints are in poor condition. That’s because during recovery from the replacement of one knee, you need the other knee to work harder. If the other knee hurts when you place weight on it, this will make it difficult for you during physical therapy and would also slow your recovery.

To do well in rehabilitation after simultaneous surgery, however, you need good arm strength. That’s because you’ll be using crutches or a walker, which require strong arms.

Simultaneous replacement slightly increases the risk of blood clots or heart attack. However, such complications are rare. Still, simultaneous replacement is not for everyone. It is not recommended for patients with heart or lung disease, or people over 80.

There are also benefits to separate operations months apart. These include a reduced risk of post-surgical infection and less chance of needing a second surgery on either knee, to fix problems with the first surgery.

So having both knees replaced simultaneously surely is a reasonable option for many people. You and your doctor need to consider all of the issues mentioned above.

Personally, I’m under 80; my arms are strong, and I have fun using crutches. So, if both of my knees had come to the end of the road and needed replacement, and if I had no underlying heart or lung disease, I’d probably choose simultaneous replacement of both knees.

Whether you have your knees replaced together or separately, you’ll need to actively participate in a rehabilitation program. It is critically important to your rapid recovery from the surgery.

(This column is an update of one that ran originally in August 2013.)