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Can Both Knees Be Replaced At The Same Time

What Is The Bilateral Simultaneous Knee Replacement And How Does It Work

Bilateral Total Knee Replacement – Should I Replace Both Knees At The Same Time?

Mr Henry BourkeHistorically, knee replacements have been done one at a time. It is a reasonably big operation for the patient with a degree of blood loss sometimes requiring transfusion. Losing blood can stress the cardiovascular system somewhat and thus, up until recently, doing two procedures has not been safe for the patient. Better advances in anaesthesia and better surgical techniques have been able to minimise the risk to the patient and allow us to operate on both knees in the same sitting. Many surgeons around the world will offer patients two knee replacements in the same sitting but this involves replacing one knee, sewing up the skin and then starting on the other knee. This leads to a fairly prolonged anaesthetic time of 2.5-3 hours. Bilateral simultaneous knee replacement means two surgeons are operating at the same time, one on each knee. This means that both knees can be replaced inside one hour. The advantage of this is much less anaesthetic time which is in theory much safer for the patient leading to a quicker recovery in addition.

Mr Rakesh KucheriaBilateral knee replacements can be done either sequentially or simultaneously. Simultaneously, is when two surgeons are operating at the same time, which means within an hour to an hour and a half both knees are replaced. This reduces the time under anaesthesia, as well as exposure to the atmosphere, making it more beneficial for the patient.

Why Replace Multiple Joints

Some people who need joint replacement surgery only have degeneration or arthritis in one joint. For them, a single surgery may be the only treatment they need.

Other patients, especially those with arthritis, have pain in several joints. Arthritis can attack both knees, your shoulder and hip, etc. In this case, you may need to replace multiple joints.

Double Knee Surgery Versus Single Knee Surgery Which Is Best For Me

If knee pain or problems in both your knees is interfering with your wellbeing and participation in the activities you love, you might be recommended to undergo surgery for the replacement of both knees.

There are two options to consider when you require two knees to be replaced:

  • Staged bilateral knee replacement in which your knees are replaced in two separate, single knee replacement surgeries.
  • Double knee replacement surgery in which both knees are replaced in the same operation.

As with any medical treatment, there are pros and cons to each approach.

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How Knee Replacement Surgery Works

The medical term for total surgery is total knee arthroplasty, or TKA. This procedure involves removing structural portions of your knee joint and replacing them with mechanical parts. Because TKA removes all of the in the joint, your knee wont hurt when you walk after getting it replaced and completing rehabilitation.

Traditionally doctors have replaced just one knee at a time, in two separate surgeries spaced months apart. This is called staged TKA. But some orthopedic surgeons now will offer to replace both knees at once. This procedure is called simultaneous bilateral total knee , or more commonly double knee replacement.

Who Can Get The Procedure And Who Shouldnt

Can I Replace Both Knees at Once?

Mr Henry BourkeThe ultimate decision on who is suitable for this procedure lies with the anaesthetist. We work with two anaesthetists regularly and patients will have an appointment with the anaesthetist prior to the operation assess their general health and to identify potential existing illnesses that may make the operation riskier. These comorbidities are usually bleeding disorders, prior cardiovascular problems such as previous heart attack and problems with the respiratory system . From the surgeons perspective we feel the patients need to have an overall fitness level to allow them to get up out of bed after the operation to mobilise with a frame or crutches. This requires a certain amount of upper body strength and muscle power in the legs to get going again quickly on two replaced knees. Having this procedure also requires a certain amount of family and/or social support as it can be quite tough in the first few weeks to get about on the two new knees, obviously if you are not able to rely on one that you have known for many years.

Mr Rakesh KucheriaAnyone who has got bad knees and are in reasonable health can have this procedure. Patients who should not have both knees done simultaneously are those with cardiac issues or other high-risk factors towards having surgery.

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Do You Need An Alignment After Replacing Struts

wouldalignedstrutsstrutsalignmentyouyoualignmentstrut replacementSymptoms of bad shocks or struts include:

  • Badly cupped tires and/or noticeable tire shaking, wheel shimmy or vibration after hitting a bump.
  • Suspension bottoming on rough roads or when backing out of a driveway.
  • A bouncy ride.
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    Potential Complications With A Bilateral Knee Replacement

    In the United States, about 600,000 people get knee replacement surgery each year. Severe side effects, such as infection, are uncommon. They only happen around 2% of the time. However, as with any surgery, complications can happen when you least expect them. Below, we list the most common complications associated with knee replacements.

    • Anesthesia complications
    • Allergic reactions to metal pieces
    • Bleeding and wound complications

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    It’s Easy To Get The Care You Need

    See a Premier Physician Network provider near you.

    If youre faced with replacing both of your knees, is it better to have them done at the same time? Or should you wait until the first replacement has healed before having the second knee replaced?

    Orthopedic surgeons Richard Davis II, MD, and Matthew Lawless, MD, have extensive experience withknee replacement surgeries. Although not every patient is a candidate for bilateral knee replacement , they say there are advantages.

    Is It A Good Idea To Have Both Knees Replaced At The Same Time

    Help Me With My Pain | Should I get both of my Knees replaced at the same time | Melissa Meiste

    Trying to decide if you should have a knee replaced is hard. But what if you need to have two knees replaced? Should you have them both done at the same time? That decision can be even harder. Fortunately, you dont have to decide on your own.

    Vasili Karas, MD, is an orthopedic surgeon who specializes in hip and knee replacements as well as complex reconstruction surgery at Chicago Orthopaedics and Sports Medicine. With his advanced training and expertise in orthopedic surgery, you can trust Dr. Karas to guide you through the decision-making process when youre considering knee replacement surgery.

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    How Long Will The New Knee Joint Last

    For 8090% of people who have total knee replacement, the new joint should last about 20 years, and it may well last longer.

    If you’ve had a partial knee replacement, you’re more likely to need a repeat operation about 1 person in 10 needs further surgery after 10 years.

    The chances of needing another operation is greater if you’re overweight and/or involved in heavy manual work.

    Is There Anything Else You Can Tell Us About The Procedure Yourselves Or The Benefits That Would Be Of Interest To Our Readers

    Mr Henry BourkeBoth Mr Kucheria and I are still learning. We have only been doing this for a few years and after each case we gain more experience. We have been following up the cases that we have done so far and are particularly interested in the feedback from our patients. One of the drawbacks of having a staged procedure is going through the operation and the recovery and then having to do it all over again. The patients that have been through bilateral simultaneous procedures have been very relieved that once it is all over, they do not have to go back into hospital again as you only do have two knees luckily! We have submitted our work to a number of specialist societies around the world and are hoping to present the data and our experiences to an international forum later on this year. Our philosophy is to try to improve patient experience as osteoarthritis of the knees is often a symmetrical disease, it seems logical to me to try to treat the disease in one go, which means operating on two knees and then in theory nothing further needs to be done after that.

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    What Is Outpatient Bilateral Total Knee Replacement

    An outpatient bilateral total knee replacement means that the two joints are repaired over time in an outpatient same day surgical center. The goal of a bilateral knee replacement surgery is to remove both affected joints along with any painful arthritis that has formed and replace them with two fully functioning prosthetic knees. Jeffery T. says, The best thing about having this surgery was not having the pain anymore.Knee replacement surgery requires a surgeon to repair the damaged knee joint by replacing the original surface with a prosthesis. The prosthetic is made of metal, ceramic, and plastic and it can restore the function of the knee and eliminate the pain of arthritis. Bilateral knee replacement surgery means that both knees are replaced, sometimes, as in the case of Jeffrey, each knee is repaired consecutively, several months apart.

    The knee itself is a complex, weight supporting joint. The knee joint works to bring together the two long bones in the lower and upper leg , holding them at the flex point with muscles, ligaments, and tendons. Each bone is covered by a softer layer of cartilage that works as shock absorbers to keep the bones from rubbing together. Knee replacement removes the damaged portion of the knee itself and replaces it with a prosthesis cemented to the remaining bone.

    Advantages Of Bilateral Knee Replacement Surgery

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    Although it may seem like a big undertaking, having both of your knees replaced at the same time does have its advantages. The biggest benefit is the obvious one: significantly less pain than before surgery. Some of the other benefits include:

    • May shorten your rehabilitation
    • Only one hospitalization for two conditions
    • Recovery may be shorter
    • Only one leave from your job

    Another advantage of having both knees replaced at once is that you can get back to your normal activities much quicker. The rehab and physical therapy is usually much more intense for bilateral surgeries, making your recovery smoother and quicker in the long run.

    These advantages are mostly dependent on you and your motivation for recovery. The other big factor is how healthy you are. The younger and healthier you are, the more likely a bilateral knee replacement will work out in your favor.

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    Improve Your Range Of Motion With Exercise

    Your therapist will prescribe exercises to help you move your knee freely. Youll need to get involved in exercises such as:

    • Step-ups on stairs
    • Leg balances using one foot to stand at a time
    • Partial bending of the knee
    • Raising your toe and heel while standing

    Your goal should be to increase the range of motion to over 110 degrees at 11 weeks. You should be able to increase mobility with little or no pain.

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    Its Easy To Get The Care You Need

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    If youre faced with replacing both of your knees, is it better to have them done at the same time? Or should you wait until the first replacement has healed before having the second knee replaced?

    Orthopedic surgeons Richard Davis II, MD, and Matthew Lawless, MD, have extensive experience withknee replacement surgeries. Although not every patient is a candidate for bilateral knee replacement , they say there are advantages.

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    Can I Replace Both Knees At Once

    • Dr. Stanford Israelsen, orthopedic surgeon

    One of the most asked questions I get during appointments at Wyoming Orthopedics & Spine is if both knees can be replaced at once.

    My answer has always been the same: I dont offer this kind of surgery because studies have shown significantly higher risks in operating on both knees at once than if doing one knee at a time.

    My answer has understandably been frustrating for some patients, especially those working with a relatively short window to return to work or some other activity. However, I believe that one of my primary roles as an orthopedic surgeon is to prevent complications for my patients.

    As typical with many areas in medicine, research in this area continues to evolve and some more recent studies have been published that show replacing both knees at the same time can be safe in SELECT patients. This group of select patients includes those who are under 70 years old without major medical problems like heart disease, diabetes, COPD, smoking or obesity. After age 70, or with one or more of the medical conditions listed, single total knee replacement can be done, but complication rates rise significantly if both knees are operated on at once. When two knee replacements are done, one after the other, they can be done as soon as eight weeks apart.

    While I certainly dont believe that replacing both knees at once is the right choice for everyone, I do understand that in the right patient it can simplify the process.

    Are There Any Reasons Why I Cant Have A Knee Replacement

    Is it possible to get both my knees replaced at the same time.mp4

    Unfortunately, some people may not be able to have a knee replacement even though their arthritis is very bad. This may be because:

    • your thigh muscles are very weak and may not be able to support your new knee joint
    • there are deep or long-lasting open sores in the skin below your knee, increasing your risk of infection.

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    Do I Have A Helper For My Recovery Period

    If you opt for simultaneous replacement, you wont be able to use either of your legs normally for most of your recovery period. After a hospital stay of up to 10 days, you need assistance at home for up to six weeks. If a family member cant help out, you may need to hire a home health worker.

    If you have your knees replaced in stages, your second operation isnt scheduled until about three months after your first operation. Your hospital stay is shorter per surgery and each recovery period is quicker, too. While you may need a helper for the first week, once youre released from the hospital with an assistance device such as a walker, crutches, or a cane you should be able to get around the house on your own without too much help during your 3-6 weeks of recovery

    Double Knee Replacement Recovery

    At an initial consultation with an , you will discuss the pros and cons of a bilateral TKA. If you qualify and decide to proceed, the doctors office will schedule the surgery and provide you with complete pre- and post-op instructions.

    You can expect to spend at least one night in the hospital after your surgery. After the surgery, you will begin rehabilitation almost immediately, while youre still in the hospital. You will continue with for several weeks after you go home.

    Many knee replacement patients report that their level of post-operative pain is actually lower than the they were experiencing from the arthritis. You can be assured your surgical pain will be managed with medications during the initial recovery period.

    Simultaneous bilateral can be a great choice for those with severe, disabling arthritis in their joints. With just a single trip to the operating room, you can literally get back on your feet and enjoy a robust lifestyle again.

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    How Do You Find Working Together On The Same Patient At The Same Time

    Mr Henry BourkeIt is relatively straightforward performing knee replacement once you have the experience of doing a few hundred, however operating with somebody next door to you, requiring the same instruments as you at the same time can be a challenge. It helps that we understand each others surgical techniques and usually we can predict who needs which instrument when. As previously discussed, having a left-hand and right-hand combination of surgeons does help as we do get in each others way less. It has been interesting working together as I have certainly learnt many techniques from Mr Kucheria as it is not often as a Consultant you operate with another Consultant and this has been enormously beneficial. We also have the ability to help each other out as some cases can be challenging and we frequently will ask each others opinions and help each other out during the operation to ensure the surgery is done to the best and highest standard.

    Mr Rakesh KucheriaWorking together on the same patient at the same time can be difficult but fortunately, because I am right-handed and Mr Bourke is left-handed this means we do not clash whilst doing the operation.

    Who Is A Good Candidate For Bilateral Replacement

    Bilateral Total Knee Replacement

    The best candidates are those who are active and have strength in the muscles, ligaments and tendons around their knees.

    Youll also fare better if your general health is good. Its best if you have few other medical problems, such as any heart or lung disease.

    Even then, Dr. Greene says, you should approach simultaneous surgery cautiously.

    If youre young, healthy and a risk-taker, you can contemplate doing both knees, he says. I tell people the day of surgery, though, to tell me which knee is worse. That way, if the anesthesiologist tells me we need to stop after one knee which actually hasnt happened the more symptomatic knee is fixed.

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