BILATERAL TKR

There are actually two types of bilateral TKR.  One is simultaneous bilateral TKR whereby both knees are replaced during the same surgery on the same day.  The other is staged bilateral TKR whereby both knees are replaced at different times either days or months apart.  For those who only need to replace one knee, its called unilateral TKR.  Lets look at the pros and cons of simultaneous and staged bilateral TKR.

SIMULTANEOUS BILATERAL TKR

Simultaneous bilateral TKR appears to be the most logical thing to do as it involves one surgery, one anaesthesia, one hospitalisation  and one recovery.  It also saves a lot of time and costs.  If both of your knees are equally bad, then you are a candidate for simultaneous bilateral TKR.   Of course, this is not a decision to be made by you alone as it also depends on the recommendation of the Orthopaedic Surgeon (OS).  As this procedure requires a longer surgery and is more demanding on the body, patients who have cardiovascular problems, pulmonary disease or are over the age of 80 are usually advised against a simultaneous bilateral TKR.  Studies have shown patients undergoing simultaneous bilateral TKR have a slightly higher risk of cardiac events and needing blood transfusion.  The risk of complications such as infection, blood clots or pulmonary embolism is the same for both simultaneous and staged replacement.

In my case, I did not hesitate at all to do a simultaneous bilateral TKR as both my knees were equally bad.  As I was only 49+ at that time and relatively healthy, my OS did not have any problem with my decision.  We did not even discuss about any other option.  And I am so glad that I did that because now I have two pain free knees with one surgery.

However, many people worry that replacing both knees simultaneously may pose a problem in recovery as they do not have a good leg to work with.  Yes, during my recovery, I did experienced difficulty in getting up from a chair or toilet bowl due to the weak muscles and the stiffness and tightness in both knees.  It was exhausting as I have to rely on my upper body strength to pull myself up.  So if you have a strong upper body, it would be a great help.  However, walking is not a problem at all.  Eventually, it just got easier and easier when my muscles begin to strengthen.  For more elderly patients, I would imagine that they may take a little longer in recovery but it would still be worth it as they only have to deal with one recovery as opposed to two recovery if they have a staged bilateral TKR.

I have come across a lot of people from my TKR forums who have done simultaneous bilateral TKR and they are so glad they did that and would not have done it any other way. 

STAGED BILATERAL TKR

I understand that some OS does not advocate the practise of simultaneous bilateral TKR.  They prefer to do a staged replacement in order to minimise the risk of complications.  For this reason, I have come across people who did their bilateral replacement within days apart but during the same hospitalisation.   Then there are some who did it within one month apart and some within several months apart.  I have great admiration for these people as they have the courage to go through two surgeries within a short time frame.

For those who are in the high risk group in terms of age and medical condition, the staged replacement appears to be safer than simultaneous bilateral TKR.  These are factors that your OS would consider in order to make the necessary recommendation.

The disadvantages of doing a staged bilateral TKR involves having to deal with two separate surgeries, two anaesthesia, two hospitalisations and two recoveries.  And the time and costs spent would be much more than a simultaneous bilateral TKR.  Additionally, there are people who ended up with one good knee because the fear of going back to do the other one is too great.  So these are factors for those who are suitable candidates for simultaneous bilateral TKR to consider when making a decision.  And you need to find an experienced OS who is willing to do a simultaneous replacement.

Overall, the result of both simultaneous and staged bilateral TKR is the same in terms of pain relief and knee function.