Expert Advice on Bilateral Knee Replacement

Orthopedic surgeons perform almost 700,000 knee replacements in the United States each year, and the procedure has a high success rate in alleviating pain and restoring an active lifestyle. It’s not uncommon for patients to have arthritis in both knees, so they may need to decide, along with their surgeon, whether to have both knees replaced at the same time.

Should I have both knees replaced at the same time?

This procedure, known as a bilateral knee replacement (or double knee replacement), has both pros and cons. Your orthopedic surgeon and you must carefully weigh both before you make a decision.

What are the pros of double knee replacement?

• Having both knees replaced at the same time enables patients to get back to their normal lives more quickly.
• Patients have one surgery, one hospital stay, and one course of rehabilitation.
• Patients generally take less time off from work.

What are the cons of double knee replacement?

• Studies show there is a greater risk of complications, including cardiovascular problems and blood clots.
• There is a greater risk of blood clots in the lung, called a pulmonary embolism.
• Patients lose more blood, so there may be a need for blood transfusions. Of note, blood transfusions are rarely needed for a single knee replacement.
• Having double knee replacement may be more painful initially, so you must have a good pain tolerance. Pain management is available for all patients following surgery.
• Recovery and rehabilitation are much more challenging because greater physical and emotional strain is placed on the body. Rehab is also more difficult because patients are unable to rely on a stable leg for support. Physical therapy sessions are not longer, but the therapist needs to divide the time to rehabilitate each knee.
• Patients who have a double knee replacement must go to a facility for rehab after surgery. After a single knee replacement, most people go straight home and have physical therapy at home.

Who is a candidate for double knee replacement?

Candidates for the procedure must be in excellent health, aside from their arthritis, with no underlying medical problems. They must have no history of heart, lung, or kidney disease or other major medical issues. At Hospital for Special Surgery, bilateral knee replacements are not performed in individuals over 75 years old due to the greater risk of complications in older patients. Same-day double knee replacement is also out of the question for individuals of any age with a serious medical condition. Severely overweight patients who have a BMI of 40 or greater would not be candidates for the bilateral procedure.

Patients also need to be psychologically prepared for the intensive rehabilitation of double knee replacement entails. Patients who are considering bilateral knee replacement must have support at home as they cannot manage themselves independently. With careful patient selection, the overall success rate is high for bilateral knee replacement. (Find a knee replacement surgeon at HSS to suit your specific condition, location and insurance.)

What is the recovery timeline for a double knee replacement?

Assuming a straightforward recovery without a complication, most patients need 3 to 6 months to fully recover.

Advances in total knee replacement

Not long ago, many people thought that if you had one knee replaced, the pain and rehab would be so taxing you wouldn’t want to come back for surgery on the other knee. But with today’s advances in knee replacement surgical technologies and techniques, anesthesia and pain management, the recovery for a single knee replacement at a high-volume knee replacement center is much easier and faster than it was in the past. At Hospital for Special Surgery, virtually every patient comes back for the second knee replacement, generally waiting at least three months in between surgeries.

Know what to expect before having a double knee replacement

Whether a person is having two separate procedures or both knees replaced at the same time, the orthopedic surgeon should have a detailed discussion with their patient about risks and benefits and what to expect following surgery. Because of the special considerations involved in bilateral knee replacement, it’s especially important to choose a highly experienced orthopedic surgeon who specializes in total joint replacement.

Patients should also choose a hospital that performs a high volume of joint replacements, such as Hospital for Special Surgery, as studies demonstrate that having total joint replacement surgery at a high-volume orthopedic center has a lower risk of complications, such as infection, and a greater likelihood of success. The entire staff will be accustomed to dealing with the needs of patients before, during and after the surgery. Having a well experienced team is critical to a successful result and involves not just the orthopedic total joint replacement surgeon but also the medical clearance team, anesthesiologist, operating room staff, nurses, physical therapists, and pain management team.

Knee replacement is a big step, but knowing the facts can help patients make an informed decision. After the surgery, most patients will tell you that in terms of arthritis pain relief and improved mobility, they wished they had done it sooner.

Updated: 3/20/2025

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References

• Gerner P, Memtsoudis SG, Cozowicz C, Stundner O, Figgie M, Sculco TP, Poultsides L. Improving Safety of Bilateral Knee Arthroplasty: Impact of Selection Criteria on Perioperative Outcome. HSS J. 2022 May;18(2):248-255. doi: 10.1177/15563316211014891. Epub 2021 May 21. PMID: 35645645; PMCID: PMC9096997. https://pubmed.ncbi.nlm.nih.gov/35645645/
• Johnson MA, Barchick SR, Kerbel YE, DeAngelis RD, Velasco B, Nelson CL, Israelite CL. No Difference in Perioperative Complications for Bilateral Total Knee Arthroplasty Staged at 1 Week Compared With Delayed Staging. J Am Acad Orthop Surg. 2022 Oct 15;30(20):992-998. doi: 10.5435/JAAOS-D-22-00135. Epub 2022 Jun 29. PMID: 35916881. https://pubmed.ncbi.nlm.nih.gov/35916881/
• Kahlenberg CA, Krell EC, Sculco TP, Katz JN, Nguyen JT, Figgie MP, Sculco PK. Differences in time to return to work among patients undergoing simultaneous versus staged bilateral total knee arthroplasty. Bone Joint J. 2021 Jun;103-B(6 Supple A):108-112. doi: 10.1302/0301-620X.103B6.BJJ-2020-2102.R1. PMID: 34053281. https://pubmed.ncbi.nlm.nih.gov/34053281/
• Malahias MA, Gu A, De Martino I, Selemon NA, Ast MP, Sculco PK. Staggered bilateral total knee arthroplasty during a single hospitalization: is it still an option? a systematic review. Musculoskelet Surg. 2022 Jun;106(2):207-217. doi: 10.1007/s12306-021-00696-w. Epub 2021 Mar 15. PMID: 33721261. https://pubmed.ncbi.nlm.nih.gov/33721261/
• ​​​​​​Malahias MA, Manolopoulos PP, Mancino F, Jang SJ, Gu A, Giotis D, Denti M, Nikolaou VS, Sculco PK. Safety and outcome of simultaneous bilateral unicompartmental knee arthroplasty: A systematic review. J Orthop. 2021 Feb 19;24:58-64. doi: 10.1016/j.jor.2021.02.019. PMID: 33679029; PMCID: PMC7907672. https://pubmed.ncbi.nlm.nih.gov/33679029/<

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