Bilateral knee replacement surgery means that both knees are replaced. Patients who have severe knee arthritis in both knees may be good candidates to undergo bilateral total knee replacement.
In general, there are two types of bilateral knee replacement surgery :
- Simultaneous Bilateral Knee Replacement A simultaneous procedure means that both knees are replaced at the same surgery, in one day.
- Staged Bilateral Knee Replacement A staged procedure means that the knees are both replaced, but not on the same day. The second surgery may be performed as early as several days after the initial surgery, or several weeks or months later.
Who should consider bilateral knee replacement?
Patients who have severe knee arthritis in both knees may be candidates for bilateral knee replacement surgery. The same criteria used to determine if a single knee requires replacement are used to determine if both should be done:
What are the risks of a simultaneous bilateral knee replacement?
There are concerns about performing a simultaneous knee replacement because it is a longer surgery and is more demanding on the body. Because of this, patients who have cardiovascular problems, pulmonary disease, or are over the age of 80 are often advised against a simultaneous knee replacement procedure.
Studies have shown patients undergoing simultaneous knee replacement have a slightly higher risk of cardiac events and needing blood transfusion. Overall, the risk of severe complications such as infection, blood clots, pulmonary embolism or death is about the same for both simultaneous and bilateral procedures.
Another disadvantage of the simultaneous knee replacement is that the early rehabilitation can be more difficult as patients do not have a "good leg" to work with.
What are the benefits of a bilateral knee replacement?
The benefit of simultaneous knee replacement is that both problems are taken care of at one time. The overall rehabilitation is a shorter time, and there is only one hospitalization. Patients also only require one anesthesia.
Is having a bilateral knee replacement my decision to make?
Yes and no. Patients who are appropriate candidates for a simultaneous knee replacement can decide if they want both surgeries at the same time. However, your doctor may recommend against a simultaneous procedure if you have medical conditions that may place you in a higher risk category.
Can partial knee replacement be done as a bilateral procedure?
Yes. The same criteria are used to determine if patients who require bilateral partial knee replacement are appropriate to undergo this procedure as a simultaneous surgery.
Who is a good candidate for partial knee replacement?
The minimally invasive partial knee replacement is indicated in patients who have severe arthritis of the knee that have failed conservative treatments may consider this procedure. Conservative measures may include, but are not limited to, medications (such as Advil, Naprosyn, Celebrex, and Vioxx), cortisone injections, strengthening exercises, and weight loss. If these treatments are not adequate, and you as a patient are not satisfied, then surgical procedures may be considered.
The partial knee surgery may be possible if the arthritis in the knee is confined to a limited area. If the arthritis is widespread, then the partial knee replacement is NOT appropriate, and should not be considered.
In addition, the partial knee surgery is recommended in patients who are:
- Older than 55 years
- Not obese
- Relatively sedentary
- Have intact ligaments (specifically the ACL)
If these qualifications are not met, then the minimally invasive partial knee surgery may not be as successful. Unfortunately, many patients are therefore ineligible for this minimally invasive procedure.
What is the problem with most patients for the partial knee replacement?
Most patients who seek surgical management have arthritis that is too advanced for the minimally invasive partial knee replacement procedure. Because surgical treatment is considered a 'last-resort' by most patients, by the time surgery is necessary, their arthritis is too advanced to consider this minimally invasive procedure. If partial knee replacement is done in a patient who is a poor candidate, failure rates can be high, and conversion to a traditional total knee surgery may be more difficult.
What is the benefit of the Bilateral knee replacement?
A traditional knee replacement surgery involves an incision about 8 inches over the front of the knee. There is more significant dissection necessary to complete the procedure compared to the unicompartmental knee surgery. In the minimally invasive partial knee replacement, the incision is about 3 inches, and the amount of dissection and bone removal is much smaller.
Less Blood Loss
Because of the extent of dissection and bone removal necessary for a total knee replacement, the need for a blood transfusion is relatively common. With the unicompartmental knee procedure, a blood transfusion is infrequently needed, and patients do not need to consider giving blood preoperatively.
Both the time in hospital and the time to functional recovery are less with the partial knee replacement. Patients are known to have been discharged on the day of the procedure, although most often patients are discharged on the first or second post-operative day. With traditional total knee replacement, patients seldom leave before three or four days in the hospital, and often require a stay in an in-patient rehabilitation unit.
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