Double Hip & Knee Replacements: The Pros & Cons

A single hip or knee replacement can be stressful enough. But what happens when you need both done? Is it better to get both joints replaced at once? Or is it safer to stage your replacements, building-in recovery time? For those who've been diagnosed with severe osteoarthritis in both joints, the double knee replacement or double hip replacement versus a single replacement is a serious debate. Although there are pros and cons to both, it ultimately comes down to a few different factors (including health and lifestyle).

A double joint replacement is also called a "bilateral joint replacement". A "simultaneous bilateral joint replacement" refers to a double replacement where both hips or knees are replaced in the same surgical setting. A "staged bilateral joint replacement" is when the hips or knees are both replaced in separate surgical events.

Are you considering a double hip or double knee replacement? Read on as we talk through the pros and cons of a simultaneous replacement versus a staged replacement.

Pros and Cons of a Simultaneous Double Joint Replacement

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Thinking it's best to space out your double joint replacement? Like the idea of having your replacements "wham, bam, thank-you ma'am" over with? There are pros and cons to both. Here's what you should know.

Pros

  • One surgery. Having both replacements done together means only one hospital stay, undergoing anesthesia once (which carries some risk) etc.

  • One recovery. Only have one stint needing prescription medication, not being able to drive, taking time off work etc.

  • Rehabilitate both hips or knees at the same time during physical therapy and at-home ReHab.

  • Better usage of insurance deductible.

Cons

  • Increased risk of complications (double replacement mean two incisions, two surgical sites to tend to, greater chance of blood clots etc.).

  • 1+ extra days spent in hospital after surgery (less chance of same-day discharge)

  • Greater stress on your cardiovascular system (heart and lungs) during surgery and recovery

  • Higher chance of needing a blood transfusion after surgery.

  • Longer surgical procedure (the longer the surgery, the slightly higher the risk associated).

  • A more intensive recovery and ReHab (can be very strenuous for some patients).

  • Not everyone is a candidate (we get into this below).

In saying this, some of the "cons" to a simultaneous bilateral replacement like "increased risk of complications" or "longer surgical procedure" should be looked at at both ends. As in, although having two replacements done at once is higher risk than having a single replacement, having two separate surgeries is also higher risk than having one surgery. See what we mean? Tomato/ Tomatoe!

One surgery, two replacements = some risk. Two surgeries, one replacement = some risk.

Who is the Best Simultaneous Bilateral Replacement Candidate?

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To answer "who is the best candidate", we asked Dr. Wayne Trevor North, orthopedic surgeon at Henry Ford in Detroit. As an orthopedic surgeon Dr. North determines which patients he thinks are suitable for a double hip or knee replacement in a single surgery, or who should space out their procedures. Dr. North explains, "With a double hip replacement or double knee replacement you should be cognizant of your overall health and physical shape...Doing both joints at the same time (although a little bit counterintuitive) is reserved for healthier patients who can recover more easily."

When it comes to determining who qualifies for a simultaneous bilateral joint replacement, your surgeon will be very careful with patient selection. He/she will look at specific indicators to ensure you meet the criteria.

The best candidates for a simultaneous double replacement are:

  • In good overall health

  • Average or better physical fitness

  • Not overweight

  • Motivated to work through intensive physical therapy and ReHab

  • Younger in age (under 65)

  • Has support at home for recovery

  • Have badly deformed joints (neither side is strong/healthy enough to support a surgical joint through recovery).

If both joints are severely degenerated but the patient is healthy and can withstand a challenging recovery, doing two replacements at once can make the most sense. Since your non-surgical side will "carry a lot of the load" (literally and figuratively) during recovery, it needs to be strong enough for you to get out of a chair, support you going up the stairs, stabilize you getting in and out of the shower etc. If neither knee or hip are able to support the surgical side, it may make the most sense to do both together.

Dr. North explains, "One consideration is how bad the deformity is. Other things to look at are: how bad the pain is and how poor mobility has gotten. If both sides are badly deformed and you think that you're going to have a difficult time rehabilitating with the support of your non-surgical side, that's one reason to get both done together."

Tips for Patients Having a Simultaneous Double Hip or Knee Replacement

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According to a study in the Journal of Orthopaedic Surgery, "Simultaneous bilateral TKR is safe for properly selected patients."

So, you and your surgeon have decided to move ahead with a simultaneous double replacement? Or maybe you're leaning toward this option but haven't quite decided? For many patients, the pros outweigh the cons. If you are in good overall health, have a support system in place, and are mentally and physically able to devote yourself to recovery, it can be a great option. After all, if you know two replacements are on the horizon, it's a major plus to just endure one recovery period (even if it is a bit more challenging).

As I am sure your surgeon has pointed out, before any elective surgery, especially in the case of a double replacement, there are many things you should do to lower your risk. You play the largest role in your outcome and can actively work today to make tomorrow's recovery safer and easier.

With that, here's what you should do before your double replacement:

1) Choose the Right Surgeon.

If you're reading this article, there's a chance you've already selected your orthopedic surgeon. However, if you haven't (or aren't completely comfortable with your chosen surgeon), there are things you should look out for or ask of your surgeon.

Things to ask:

  • What is your surgeon's complication rate?

  • What is the hospital or outpatient clinics infection or MRSA (Methicillin-resistant Staphylococcus Aureus) rate?

  • Does your surgeon perform robotic-arm assisted joint replacements?

  • What is your surgeon's experience with simultaneous bilateral replacements?  

  • What is your surgeon's typical surgery time? (if your surgeon performs his/her replacements at a slower pace, double replacement may not be the right option).

All of this information is publically available or can be asked at your appointment. Here is a lot more information on how to choose the right surgeon, what to look out for, and how to find statistics on a surgeon's complication rates etc. In order to be comfortable having a double replacement, you need to be confident in your surgeon. Working with a surgeon who has lower complication rates, who is experienced with bilateral replacements, who has done several cases with robotic-arm assisted technology etc., are all great signs of an experienced, competent provider.

Read Jim's story. He had a staged double knee replacement using robotic-arm assisted technology. See how he prepared!

2. Prepare with PreHab (it's a must!)

What you do to prepare for surgery (physically, mentally, and environmentally) directly impacts your recovery. In the weeks leading up to surgery, it is absolutely imperative to actively work at lower your pre-op and post-op risk. This means strengthening your joints and their supporting muscles, losing extra weight, learning drug-free pain management techniques, engaging in mindfulness to reduce anxiety etc. Whatever you put into getting ready for surgery, the more you will get out of it tenfold. Many patients swear by PreHab (of course, we recommend PeerWell's daily joint replacement PreHab program for your smartphone or device).

What is PreHab? PreHab is actively putting forth effort to get your body and mind prepared for surgery. PreHab should involve all of the various learnings and activities that are proven to positively impact surgery outcomes and reduce recovery times. Instead of just relying on your care team, PeerWell puts you in the driver's seat of you own surgery and recovery.

Learn more about PreHab and when to do PreHab before your hip or knee replacement surgery.

3. Get the Support You Need

There are a few aspects of support when it comes to your bilateral replacement. First off, you'll need emotional support as you get ready for surgery—peer support is great for this. Afterwards, you will need more physical support from family and friends as you recover at home.

Before surgery, sticking with a daily PreHab program to get you to your best on surgery day is a challenge. PeerWell's daily program is broken down into short 10-15 minute daily activities that have the greatest impact on your surgery outcome and recovery. Although everyone can spare 10 minutes a day, it can be hard to stay motivated. Part of sticking with PreHab is peer support and being part of a community of others going through the same thing.

We recommend you join Hip & Knee PreHab Surgery Advice & Support—several people in the group have undergone double replacements or are preparing for their surgery.

After surgery, peer support is also important for getting advice, airing grievances, checking-in on what's normal etc. Even more importantly, you will need to line-up trustworthy caregivers to assist in the first few weeks of your recovery. You will need help moving throughout the house, getting to the bathroom, making meals etc.


Preparing for your knee or hip replacement surgery? Whether you're having a simultaneous bilateral, staged bilateral, or single replacement, PeerWell's PreHab program (and follow-up ReHab program for recovery) tips the scales in your favour for a faster, easier recovery. Lower your risk and get back to the new you with PeerWell.

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Hi, I'm Grace. I write all things surgery for the PeerWell blog. You may remember me from such titles as: "Diabetes & Joint Replacement 101" & "Sex After a Joint Replacement".

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