Knee Replacement Surgery - Should You Have Both Done At Once?

If you are unfortunate enough to require a knee replacement on both legs, occasionally surgeons will offer to do them simultaneously. This is a big decision to make as it is obviously harder to rehabilitate when you don't have a "good" leg to rely upon.

Why would anyone do this?

Well, there are some advantages. The total recovery time is usually much quicker having them done together than the total of two separate occasions. This makes it an attractive proposition for people with a hectic schedule.
You will only have to have one anesthetic, although it will be of significantly longer duration. It is also likely to cost much less than two separate surgical interventions.

The main problem is a more difficult initial phase of the recovery. For this reason surgeons pick their candidates carefully.
Simultaneous total knee replacements will only be offered to low risk patients. They need to be free of upper limb problems due to the increased initial load on the arms when ambulating. Social factors are important also. Living with an able bodied partner in level accommodation is easier than living alone on the 5th floor with no lift. Medical complications and risk factors such as cardiovascular disease, diabetes and obesity will often see a surgeon recommend one knee at a time.

If the possibility of 2 knee replacements is offered to you, discuss it with your family,and consider how much support you will receive in the short term.

There are benefits to be had, but they are best suited for highly motivated, low risk individuals with a good support network.

Knee Arthritis Pain Medication

When you are relying on medication to get you through the day it is important to have a good understanding of what is safe. There is no substitute for trained medical advice that is specific to your medical history. None of us are the same and some drugs work better for some people than they do for others.

Again, having a basic understanding can help you ask the right questions.

Paracetamol is a common arthritis drug. Many people do not give it credit as it is readily available over the counter but studies have shown it to be effective in treating arthritic pain. It has relatively few drug interactions and side effects but it is important to stick to the recommended amount as the overdose level is not particularly well distanced from the therapeutic dose.

NSAIDs or Non Steroidal Anti-Inflammatory Drugs are also typically used to combat arthritic knee pain. Many of these drugs are also available over the counter. They do have some common side effects to be aware of such as exacerbation of asthma and gastrointestinal tract bleeding. They should always be taken after food for this reason. Aspirin is a member of this family of drugs. It is usually safe to take these drugs in combination with paracetamol.

Opioids are another category of common knee arthritis medications. Codeine (a.k.a. Tylenol 3) is often sold as a combined preparation with paracetamol. Codeine is a strong pain killer but can have serious consequences if overdosed and can cause constipation even at recommended levels. Care should be taken combining any codeine product with paracetamol as it is so common for the codeine tablet to contain paracetamol that any additional paracetamol can lead to overdose and liver damage.

If you are not happy with the relief your current analgesia is delivering, discuss your options with your physician or pharmacist. Get specialist advice as the interactions between drugs are extremely complicated and your personal medical history needs to be taken into account. Some drugs can be combined to give extra relief but this process needs to be overseen by a professional.

Waiting for a Total Knee Replacement?

Unfortunately, for many people it will eventually get to the stage where there only thing that is going to help is a total knee replacement ( also called a total knee arthroplasty).

It is not uncommon for there to be a waiting period between when the decision is made and when the operation occurs. This may be a matter of weeks or, in the case of public health systems, many months.
Once you have agreed to a knee replacement your next question should be: What can I do between now and the surgery?

1) Remain as active as possible: Don't cease all painful activity while you wait. Continue as best you can despite the pain. Decreased activity can lead to loss of muscle strength and increased knee stiffness.

2) Work those quads: The stronger your quadriceps muscle, the easier it will be for you to recover from the surgery. Even if your wait is only a few weeks, improvements can be made.

3) Educate yourself about Deep Venous Thrombosis, a potential complication of surgery. Learn what you need to do to decrease your risk. This link goes to my article on DVT

4) Prepare your house: Remove trip hazards such as rugs. Remove clutter. Do any jobs that will be difficult after your operation.

5) Practice Crutches: If you have never used crutches before, consider learning how to uses them BEFORE your operation. Try stairs with crutches with and without a rail.

These are all simple, easy things to do and they can make your recovery much more pleasant. Don't waste the time before your operation - use it to your advantage.