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Bilateral Knee Replacement: Simultaneous vs. Staged Surgery Outcomes, Risks, and Recovery

by msk-direct | 22 Sep, 2025 | Others | 0 Comments

Bilateral Knee Replacement: What It Means

Bilateral total knee arthroplasty (TKA) — sometimes called double knee replacement — means replacing both knees that are affected by arthritis. This can be done in one surgery (simultaneous bilateral TKA) or two separate surgeries (staged bilateral TKA).

The question most patients ask: Do the outcomes differ depending on which option you choose?

What the Research Shows

Safety and Risks

• In lower-risk patients, overall complication rates are similar whether the surgeries are done at the same time or staged.
• In patients with heart or lung problems, doing both knees at once increases the risk of blood clots and heart complications.
• Simultaneous surgery may have a slightly higher need for blood transfusions.

Recovery and Function

• Long-term results are very similar. Pain relief and function at 12 months or beyond do not differ between simultaneous and staged surgery.
• Early recovery differs: patients with both knees replaced may take longer in the first 6 weeks to regain independence, but they usually catch up by 12 weeks.
• Satisfaction scores are high in both groups.

Cost and Convenience

• Doing both knees at once means:
  • One anesthesia
  • One hospital stay
  • One rehab period
• This often translates to lower costs, less total time away from work or family, and greater efficiency for the healthcare system.

Infection and Implant Longevity

• Some studies show slightly lower infection rates with simultaneous surgery.
• Implant survival and revision rates are not meaningfully different between the two approaches.

The “Forgotten Knee” Effect

• More common after single knee replacement, but many bilateral patients also report it by 12–18 months — when you no longer notice your prosthetic knee in daily life.

Who Is a Good Candidate for Both at Once?

The American Academy of Orthopaedic Surgeons (AAOS) recommends that simultaneous bilateral TKA be reserved for healthier, lower-risk patients (often younger, ASA 1–2).

It is usually not recommended for people with:

• Significant heart or lung conditions
• Poor baseline mobility or function
• Limited support systems at home

👉 Want clarity on your situation? Schedule an appointment to discuss your knee journey today.

Key Takeaways for Patients

• Outcomes are very similar whether you do both knees together or one at a time.
• The real trade-off is convenience vs. safety: one recovery period versus reduced cardiopulmonary risk.
• Your overall health, activity goals, and support system matter more than the technique itself.

FAQs About Bilateral Knee Replacement

Is it safe to replace both knees at the same time?
Yes, in carefully selected patients with low heart and lung risks. For higher-risk patients, staged surgery is safer.

What is the recovery time for double knee replacement?
Expect slower progress in the first 6 weeks compared to a single knee replacement, but by 12 weeks most patients are on par.

Who should not have simultaneous knee replacement?
Patients with significant cardiopulmonary conditions or poor support at home should avoid simultaneous surgery.

Next Step

If you’re considering knee replacement, don’t just ask “when’s my surgery?” — ask which path gives you the safest recovery and the best chance of returning to the life you want.

👉 Schedule an appointment to discuss your knee journey and get a personalized plan.