Has your knee doctor advised you to get both knees replaced? Worried? It is natural to feel uncertain, because the decision to undergo surgery is not an easy one. Add to it, not one but essentially two surgeries at the same time. Although there are both pros and cons of getting both knees operated together (bilateral knee replacement), the decision should depend on whether both your knees actually require replacement.
At Sohana Hospital, we believe in a careful, personalised approach for each patient. The aim is to help you walk pain-free – be it using physiotherapy, medications, lifestyle modifications, PRP injections, hyaluronic injections, knee resurfacing, partial knee replacement, or single knee replacement. TKR or total knee replacement is often the last resort.
We advise simultaneous bilateral knee replacement or replacing both knees together, only if both your knees are in the last stage of knee degeneration and neither responds to any non-invasive or less invasive options. Additionally, it is about the personal preferences of a patient.
Not All Knees Are at the Same Stage
In most patients, knee degeneration does not always progress equally in both legs. It is common to see only one knee severely damaged while the other may continue for another 10 years or more without posing significant discomfort or hindrances to mobility.
Whereas surgery may be the most effective solution for repairing the knee in the advanced stage of degeneration, the other knee may be in the early stages of wear and tear – showing mild to moderate cartilage damage, some stiffness, or occasional swelling.
In such cases, the second knee might respond well to and be treated with non-invasive treatments like physiotherapy, targeted exercises, medications, weight management, or orthobiologics. Such an approach can delay the need for surgery for at least one knee and make you feel confident about your recovery journey.
Understanding the Degrees of Damage
Stage 1 (Minor)
Cartilage begins to lose its smoothness, causing minor friction inside the joint. Pain is missing or it is occasional, usually after intense activity or long periods of standing. Swelling is minimal, and X-rays may still appear normal. However, an MRI might diagnose the budding problem.
Treatment
- Supplements
- Over-the-counter medications – nonsteroidal anti-inflammatory drugs (NSAIDs)
- Shedding weight
- Structured exercise
- Physiotherapy
- Yoga
Stage 2 (Mild)
In this stage, you may begin experiencing pain and stiffness in your knee joint, especially with activity. Also, you may find it hard to bend or straighten your knee joint. In some people, pain and stiffness may even impair movement. Bone spurs may be visible in X-rays, but the cartilage may not show any issues. So, your healthcare provider may diagnose the problem through an evaluation of your symptoms, a physical examination, and other tests.
Treatment
- OTC medications (NSAIDs) to relieve pain
- Lifestyle changes
- Losing weight
- Low-impact exercises
- Strength training
- Supplements
- Wear a brace, knee support, shoe insert, or wrap
Stage 3 (Moderate)
Cartilage between bones starts showing signs of damage. The space between joints reduces visibly. More and bigger bone spurs may come up. Pain becomes frequent, particularly while performing activities that involve use of joints – climbing stairs, squatting, or prolonged walking. Stiffness is often more noticeable in the mornings and after sitting continuously for a long stretch of time. There may also be visible swelling in your joints. Diagnosis will be based on symptoms, physical examination, X-rays, MRI, or arthroscopy.
Treatment
- OTC medications – NSAIDs for pain
- Hyaluronic acid or corticosteroid injections
- Lifestyle changes
- Losing weight
- Exercising
- Physical therapy
- Self-care
Stage 4 (Advanced)
Cartilage drops to bare minimum or it may completely disappear. Severe cartilage loss leads to bone-on-bone contact. Joints may have negligible space between them, and the quantity of lubricating synovial fluid drops to minimal levels. Bone spurs attain a larger size. There may be severe pain in affected joints making daily activities hard. Swelling, stiffness, and inflammation may also be severe. The joint may feel unstable, appear visibly deformed, and hurt even during rest or sleep. Diagnosis depends on symptoms, physical examination, lab tests, and imaging tests like X-rays and MRI.
Treatment
TKR (Total knee replacement) – conventional or robotic
The Power of a Second Opinion
Knee replacement – whether it is for one knee or both – is a major decision. When you have to take such a significant step, there is no harm in seeking a second opinion, because it allows you to:
- Confirm the stage of degeneration in each knee.
- Discuss with your ortho doctor – whether a staged knee replacement (one-at-a-time) approach might suit you better.
- Learn about the latest surgical (invasive) and non-surgical (non-invasive) knee treatment options available.
At Sohana Hospital, our orthopaedic specialists are committed to guiding you through every possibility, so that your treatment plan is tailored to your needs, health condition, and lifestyle. We ensure that each patient who comes to the hospital leaves walking pain-free and completely satisfied.
The Bottom Line
Both single and bilateral knee replacement can deliver excellent results – when done at the right time, for the right knee(s), with the right preparation, and the right technique. If you have been told that both your knees need surgery, take a moment to pause, research and explore, ask questions to yourself and your orthopaedic doctor, and take the decision of getting knee replacement surgery of both knees together only if it is really necessary and you feel confident about it.
It is important to mention here that people who have severe degeneration in both knees may prefer to go for bilateral knee replacement because it offers benefits like – one-time hospital expenses, recovery time reducing to half as compared to that for staged knee replacement, single rehabilitation, and one-time anaesthesia.
So, make up your mind after thoroughly analysing prospects of both – unilateral total knee replacement and bilateral total knee replacement. It is about not only your mobility but also satisfaction.
