Archive October 2017 XVIII, No. 10

When Bilateral Total Knees Make Total Sense

With the right patients and right protocols, there's no good reason not to double up.

Thomas Sculco

Thomas Sculco

BIO

symmetrical arthritis DOUBLE TROUBLE Most patients who have symmetrical arthritis in both knees prefer to have just one operation, if possible, says Dr. Sculco.

Good candidates for bilateral knee replacement don't come along every day. More like every week. That's right. At the Hospital for Special Surgery, I do about 250 total knees a year, and about 50 times a year, I do both knees at the same time. Over the last several years, I've become convinced that with the right candidates, and under the right circumstances, bilateral knees make all the sense in the world. Here's why.

  • It's fairly common for patients to have symmetrical arthritis in both knees, more common than it is with hips. When you're dealing with 2 equally bad knees, you have 3 options. One is to stage 2 operations about 3 months apart. Another is to do them during the same hospital stay, usually about 5 days apart. The third option is to take care of both in one operation. In my experience, patients overwhelmingly prefer to go through one operation and not have to repeat the whole procedure and recovery again. They want to get both knees done at once and begin to move on.
  • With one operative procedure, there's just one anesthetic and you have symmetrical recovery. But if you fix just one knee, and you have a bad knee on the other side, you delay the recovery of the newly replaced knee. Many patients have flexion contractures in both knees, meaning they can't completely straighten either. When you operate on one, the newly replaced knee always takes on the posture of the bad knee. Patients often lose the correction because they can stiffen up in that flexed position.
  • It's less costly to the healthcare system to do 2 knees at once than to do them separately (about $67,000 vs. $90,000). Of course, it's also less lucrative for the surgeon, because CMS pays full price for the first knee and only half for the second, but that's a price I'm willing to pay in the best interests of my patients.
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