Bilateral Knee Replacement — Should You Do Both Knees at Once?

If both knees have severe arthritis, bilateral knee replacement may be done either in one hospital admission or as two separate surgeries. Doing both knees at once can reduce the total treatment period, but it also places a greater demand on the body and is suitable only for carefully selected patients.

The decision is not based simply on whether both knees are painful. It depends on your medical fitness, heart and lung health, age, weight, anaemia, diabetes control, mobility, home support, and the severity of arthritis in each knee.

What is bilateral knee replacement?

Bilateral knee replacement means replacing both knee joints. It can be performed in two ways:

• Simultaneous bilateral knee replacement: Both knees are replaced during the same anaesthetic and hospital admission.
• Staged bilateral knee replacement: Each knee is replaced in a separate surgery, usually separated by weeks or months.

Both approaches aim to relieve pain and restore mobility. The correct approach depends on patient safety, surgical planning, and recovery capacity.

When do patients need both knees replaced?

Bilateral knee replacement may be considered when arthritis affects both knees and causes:

• Pain while walking, standing, or climbing stairs.
• Difficulty performing daily activities independently.
• Night pain or disturbed sleep.
• Significant stiffness or deformity in both knees.
• Reduced response to medicines, physiotherapy, injections, or lifestyle changes.
• Major limitation in quality of life despite non-surgical treatment.

Some patients have one knee more severely affected than the other. In such cases, the worse knee may be operated on first, followed by the second knee later.

Simultaneous vs staged knee replacement

Research comparing simultaneous and staged bilateral knee replacement has found higher rates of complications such as blood transfusion, venous thromboembolism, acute kidney injury, and some neurological complications with simultaneous surgery in certain studies. This does not mean simultaneous surgery is unsafe for everyone; it means the decision must be individualised.

Who may be suitable for both knees at once?

Simultaneous bilateral knee replacement may be considered for patients who are:

• Medically fit for a longer anaesthetic and surgical procedure.
• Free from uncontrolled heart, lung, kidney, or neurological disease.
• Able to tolerate greater blood loss and post-operative stress.
• Non-smokers or able to stop smoking before surgery.
• Have well-controlled diabetes and blood pressure.
• Have good home support for bathing, mobility, meals, and medicines.
• Motivated to participate in rehabilitation for both knees.

Age alone does not decide suitability. A fit older patient may be a better candidate than a younger patient with uncontrolled medical problems.

Who may be advised staged surgery?

Staged knee replacement is often preferred when:

• The patient has heart disease, lung disease, kidney disease, or other significant medical conditions.
• Anaemia, obesity, or poorly controlled diabetes increases surgical risk.
• The patient has limited home support.
• One knee is much more painful or disabled than the other.
• The patient is anxious about undergoing a longer procedure.
• The surgeon believes a safer recovery is possible by separating the surgeries.

Staged surgery allows the patient to recover from the first knee before putting the body through the second operation.

Is it painful to replace both knees together?

Yes, there is usually more post-operative discomfort initially because both knees are healing at the same time. Pain-control planning is especially important, including anaesthesia, medicines, ice, swelling control, and early mobilisation.

However, patients who undergo both knees together avoid going through two separate recovery periods. Once the initial phase passes, they may progress with walking and daily activities without needing a second hospital admission later.

What is recovery like after bilateral knee replacement?

Recovery after simultaneous bilateral knee replacement can be more challenging in the first few weeks because both legs need strengthening and both knees need movement.

Typical priorities include:

• Pain and swelling control.
• Safe walking with a walker or support.
• Knee bending and straightening exercises.
• Preventing blood clots and chest complications.
• Building thigh, hip, and core strength.
• Practising stairs, sitting, standing, and daily activities.
• Gradual return to independence.

With staged surgery, the patient usually has one stronger knee to support mobility while the operated knee recovers. This can make early daily activities easier for some patients.

What are the risks of bilateral knee replacement?

Bilateral knee replacement carries the usual risks of knee replacement, but simultaneous surgery may increase the overall physiological stress because both knees are operated on in one admission.

Possible risks include:

• Blood clots in the legs or lungs.
• Excess blood loss or need for transfusion.
• Infection.
• Heart or lung complications.
• Kidney stress or acute kidney injury.
• Anaesthesia-related complications.
• Stiffness or delayed recovery.
• Need for revision surgery in some cases.

Studies have reported higher transfusion, clot, kidney, and mortality-related risks with simultaneous bilateral total knee replacement in certain patient groups, which is why careful selection is essential.

Questions to ask before bilateral knee replacement

Ask your orthopedic surgeon:

• Are both knees severe enough to require replacement?
• Should both knees be replaced together or separately?
• Am I medically fit for simultaneous surgery?
• What are my specific risks of blood loss, clots, infection, and heart or lung complications?
• How long will I stay in hospital?
• What help will I need at home after surgery?
• When can I walk, climb stairs, and return to normal activities?
• What follow-up and rehabilitation plan will I need?

Why a personalised surgical plan matters

Bilateral knee replacement is a major decision. The safest approach is not the same for every patient. For one person, replacing both knees together may be efficient and appropriate; for another, staged surgery may be clearly safer.

Dr. Aman Dua is an orthopedic and knee and hip joint replacement surgeon with M.S. Orthopedics from AIIMS, New Delhi, D.N.B. Orthopedics, and 23 years of experience. His practice, Centre For Joint Diseases, focuses on knee arthritis, joint replacement, and related orthopedic care in Delhi.

Book a consultation in Delhi

If both knees are affecting your mobility and you are unsure whether to undergo surgery together or separately, a detailed consultation can help you make a safe, informed decision.

Dr. Aman Dua

Centre For Joint Diseases

Fortis Escorts Hospital, Okhla Road, Near Sukhdev Vihar Metro Station, Delhi 110025

Phone: +91 9625440750

Hospital contact: +91-8750005633

Timings: Monday–Saturday, 10:00 AM–4:00 PM

Website: https://www.fasttrackkneereplacement.com/

FAQs

Can both knees be replaced in one surgery?

Yes. This is called simultaneous bilateral knee replacement. It may be suitable for carefully selected, medically fit patients.

Is it safer to replace both knees together or separately?

There is no single answer for everyone. Simultaneous surgery reduces the number of hospital admissions but can place more stress on the body. Staged surgery may be safer for patients with medical conditions, anaemia, obesity, or limited home support.

How long is recovery after bilateral knee replacement?

Initial recovery is often more demanding because both knees need rehabilitation. Many patients improve steadily over weeks to months, depending on health, fitness, and rehabilitation.

Which knee should be replaced first if surgery is staged?

Usually, the more painful or more disabled knee is replaced first, but the decision depends on your examination, X-rays, and overall health.

Can I walk after bilateral knee replacement?

Most patients begin standing or walking with support according to their surgeon’s protocol. The exact timeline depends on the surgical plan, medical condition, and recovery progress.