Many patients who need knee replacement surgery have significant arthritis in both knees. This raises an entirely practical question: is it better to go through surgery once and replace both knees, or to do one at a time and face two separate recoveries?
It is one of the most common dilemmas Dr. Supreet Bajwa, Fellowship-Trained Hip & Knee Orthopaedic Surgeon at Wockhardt Hospital Mumbai Central, discusses with his patients. The answer is not the same for everyone - and this guide will help you understand the decision.
What Is Bilateral Knee Replacement?
Bilateral knee replacement means replacing both knee joints, either:
- Simultaneously (both during the same operation, same anaesthesia) - called "staged bilateral" in orthopaedic terms, but colloquially referred to as simultaneous or one-sitting bilateral
- Staged (one knee first, then the second knee 3-6 months later, in two separate operations)
Both are well-established approaches. The right choice depends on your age, heart health, overall fitness, and the difference in pain between the two knees.
The Case For Doing Both Knees at Once
One anaesthesia, one recovery: The most compelling argument. Instead of two hospital admissions, two anaesthesia events, and two recovery periods - you go through it once. For most patients, recovering from both knees simultaneously takes 3-4 months rather than 3-4 months twice over (6-8 months total, staged).
Lower total cost: Simultaneous bilateral surgery shares fixed costs - operating theatre time, anaesthesia setup, hospital admission costs, physiotherapy planning. The combined cost is typically 25-35% less than two separate operations.
Balanced rehabilitation: When one knee is replaced and the other is still painful, the body compensates - placing excess load on the replaced knee and the hips. Replacing both simultaneously means rehabilitation is symmetric from the start.
One leave from work: For working patients or those with busy households, doing it once means one block of time off rather than two.
The Case For Staged (One at a Time) Surgery
Lower physiological stress: Bilateral simultaneous surgery is a longer operation (2.5-4 hours vs 1-2 hours for a single knee). It involves greater blood loss and a more demanding anaesthetic. For patients with heart disease, respiratory conditions, or those over 75-80 years, this carries higher risk.
Better mobility post-operatively: After a single knee replacement, patients can use the un-operated leg to assist during recovery. After bilateral replacement, both legs are simultaneously recovering - the early days are more demanding.
If the knees are very different in severity: If one knee is much worse than the other, it makes sense to do the worse knee first, then reassess whether the second truly needs surgery.
Sometimes the first knee's recovery improves the patient's overall function enough that the second is less urgent.
Who Is a Good Candidate for Simultaneous Bilateral Knee Replacement?
Dr. Bajwa recommends simultaneous bilateral knee replacement for patients who:
- Are under 75 years with good cardiovascular and respiratory health
- Have similar severity arthritis in both knees
- Have a healthy BMI (typically under 35)
- Have strong family support at home during recovery
- Have been medically optimised pre-operatively (haemoglobin, blood pressure, diabetes control)
Patients who are older, have significant heart or lung conditions, or have very unequal knee severity are generally better suited to staged surgery.
Cost Comparison: Simultaneous vs Staged Bilateral in Mumbai
| Approach | Approximate Total Cost | Recovery Period |
|---|---|---|
| Simultaneous bilateral (both knees) | ₹3,50,000 – ₹6,00,000 | 3–4 months |
| Staged bilateral (two operations) | ₹4,50,000 – ₹8,00,000 | 6–10 months total |
The cost savings in simultaneous bilateral reflect shared anaesthesia, OT, and hospital overheads. Insurance coverage policies differ - some insurers cover both knees in a single claim; others require separate admissions.
Recovery: What Bilateral Knee Replacement Actually Looks Like
Day 0-2: Both legs operated, both beginning physiotherapy simultaneously. This is the hardest phase - a frame or bed rails are essential. Walking with a walking frame.
Week 1-3: Walking without support, climbing stairs. Both knees bending more each day. Pain managed with oral medications and ice.
Week 3-4: Most patients are independently mobile. Return to most daily activities. Return to driving (both legs). Light exercise.
Month 3: Full recovery. Both knees are functioning.
A Practical Note on Home Setup
Bilateral recovery is more demanding than unilateral. Before surgery:
- Arrange for a family member or carer to be present full-time for the first 2-3 weeks
- Install grab bars in the bathroom
- Raise the toilet seat
- Set up a sleeping arrangement on the ground floor if possible
- Prepare and freeze meals in advance
- Arrange a physiotherapist for home visits
About Dr Supreet Bajwa
Fellowship-trained in Australia, Dr. Supreet Bajwa is one of India's leading hip and knee specialists, 12+ years, 3300+ surgeries, 35+ research publications.
He brought the Direct Anterior Approach (DAA) to India, is the only orthopaedic surgeon in Mumbai performing Cooled RFA, and uses Robotic Knee Surgery for precision most patients never knew was possible.
No long recovery. No unnecessary restrictions. Most patients walk within hours.
📍 Wockhardt Hospital, Mumbai Central & Mira Road
Frequently Asked Questions
Is bilateral knee replacement safe?
In appropriately selected patients (under 75, good health, normal BMI), simultaneous bilateral knee replacement is safe. The risk profile is higher than a single knee but well within acceptable surgical risk for most patients. Dr. Bajwa performs a thorough pre-operative assessment to confirm safety.
Can robotic surgery be used for bilateral knee replacement?
Yes. Robotic-assisted bilateral knee replacement is performed at Dr. Bajwa's clinic. The robotic system creates individual pre-surgical plans for each knee, ensuring precise fit on both sides.
Will insurance cover bilateral knee replacement?
Most policies cover bilateral knee replacement. Coverage for simultaneous bilateral (both in one admission) versus staged (two admissions) varies by insurer. Dr. Bajwa's team helps patients verify and optimise their insurance benefits before surgery.
How do I manage stairs after bilateral knee replacement?
For the first few weeks, stairs are managed one step at a time with a rail. By week 2-3, most patients are climbing stairs normally with caution. By week 6, stairs are typically comfortable.
My right knee is much worse than my left. Should I still do both together?
If the difference in severity is significant, Dr. Bajwa typically recommends starting with the worse knee and reassessing the other 3-6 months later. Sometimes relief of the primary knee is sufficient and the second is deferred for years.
Book a Consultation: If both your knees need replacement and you want to know whether simultaneous or staged surgery is right for you, contact Dr. Supreet Bajwa at Wockhardt Hospital, Mumbai Central. Call or WhatsApp: +91 9820727046