Another surgical option that must be dis-cussed is the case of the patient with end-stage arthritis in both knees. This situation requires bilateral knee replacements (surgery on both knees). The surgeon and patient need to decide whether it is best to do one procedure at a time on two different days or to per-form surgery on both knees on the same day and during the same anesthetic.Several things need to be considered when making this decision about bilateral total knee replacement.
When one knee is significantly more painful than the other, it is usually the most painful one that is operated on first. In the scenario where a single knee is done, blood loss is minimized and the patient is under anesthesia for a shorter period of time. In the unlikely event that an infection occurs, it will be confined to only one knee. It al-lows the patient to have a "good" leg to stand on to facilitate rehabilitation of the recently replaced knee. The time interval between total knee surgeries is typically about three months. By this time the first knee to have undergone surgery is usually solid and reliable and can bear the weight in anticipation of the other knee requiring surgery. The downside to separating the knee surgeries is that the patient receives two anesthetics. In addition, the recovery and rehabilitation is prolonged.
In the case where both knees have nearly equally severe symptoms, the patient and surgeon should consider bilateral TKA. The simultaneous bilateral TKA gets every-thing done at once under a single anesthetic. Doing everything at once may be an emotional and financial necessity for some patients. Rehabilitation can be performed simultaneously on both knees, thus reducing the overall length of the program. The disadvantages to this method are the pro-longed anesthetic time and a potential for increased blood loss. If an infection should occur, there is a greater chance of it affecting both knees. In addition, the longer time lying on the operating table increases the risk of blood clots. The same surgeon may perform the surgery on each knee in sequence, or the procedure may be done multaneously by two different surgeons. If the patient and surgeon both agree to it, simultaneous surgery by two different surgeons may eliminate some of the downside associated with a longer procedure.
Together the patient and the surgeon make the decision to undergo a single or bi-lateral TKA. The choice must take into ac-count the overall health of the patient as well as patient and surgeon preference. Minimizing the time taken off work must also be considered. There is no "right" or "wrong" decision; the right one is the one that works best for you.
The decision to undergo a total knee re-placement is a difficult one. Fortunately, the results are consistent and reproducible. Most patients report 90 to 95 percent improvement in terms of pain and function. It is usually a positive life change practice. Only after all the other treatment options have been considered or attempted can the patient and surgeon decide on total knee arthroplasty. Once the decision has been made to undergo the surgery, though, it is important for you, the patient, to gather as much information as possible about the procedure, recovery, and rehabilitation. There is a positive correlation between a well-informed patient and an excellent surgical result.
The patient, family, and home need to be prepared prior to surgery to make the road to recovery as smooth as possible. The next chapter will guide you in your preparation for surgery.