I have arthritis in both knees. Should both be replaced at the same time?

The two approaches

• Simultaneous: both knees replaced under one anaesthetic, with one hospital admission and one overall recovery period
• Staged: one knee first, the second weeks to months later once the first has recovered well enough, often after about three months or more

In both cases the operation on each knee is the same. The difference lies in the total stress on the body and how recovery is managed.

Potential advantages of doing both together

One anaesthetic, one hospital stay and one rehabilitation period appeal to many people, especially those who would otherwise struggle to find two periods away from work or family duties. Both legs are rehabilitated together, so neither 'good' knee is compensating for a painful one. Some patients with severe deformity in both knees find it hard to rehabilitate one knee while the other remains very painful.

Why many patients are advised to stage

Having both knees done together is a bigger physiological stress. Research suggests it carries a higher risk of complications such as blood loss requiring transfusion, heart and lung problems and blood clots, particularly in older patients and those with heart disease, lung disease, kidney problems or poorly controlled diabetes. The first weeks are also harder, with no good leg to stand on, so more help at home or a period of inpatient rehabilitation may be needed.

Staging lets you learn from the first recovery and plan the second around Ramadan, work, school holidays or travel.

Deciding in your case

At Aman Hospital in Doha, Dr. Gelber looks at the severity of each knee, your overall health together with the anaesthetic team, your age and the help you have at home. Sometimes one knee is clearly worse and should be done first; the other may then become more tolerable, or be suited to a partial replacement or continued non-surgical care.