Considering More Than One Joint Replacement? What to Expect and How to Have the Best Outcome

After multiple joint replacement surgeries, my patient Lorry jokingly calls herself a “bionic woman.” She always enjoyed an active lifestyle, so when arthritis caused by wear and tear started to take an unwelcome toll on her knees and hips, she refused to take it sitting down. Over the last six years, she has received four joint replacements – both knees and both hips – so she could enjoy life without pain.

It’s not unusual for patients to have advanced arthritis in two joints. Having four joint replacements is less common, but it does happen. I recommend that people considering multiple joint replacement surgeries do their research to find a high-volume joint replacement center and a highly experienced orthopedic surgeon who takes the time to answer all their questions and with whom they feel comfortable.

For someone having more than one joint replacement, timing and recovery are important, and no two patients are alike. If someone has painful arthritis in both knees, for example, and conservative treatments such as physical therapy and over-the-counter medication don’t help, we generally wait about three months in between surgeries. That’s about how long it takes for the body to heal and to do physical therapy and get the muscles strong again. Patients are going to be supporting their weight with the side that had the first surgery.

The experience of the joint replacement surgeon is a critical factor in knowing when it’s safe to proceed with the next joint replacement. That’s why, after the initial post-surgery visits, I generally see patients again after six weeks to make sure they’re doing well, and sometimes again after three months, before proceeding with a second joint replacement.

These days, same-day, double joint replacements are done less often, as we have found that it is better for most patients to have “staged” procedures, that is, to have the surgeries at least a few months apart. Studies at HSS show that same-day bilateral knee replacement surgery can present more challenges for the patient from a medical standpoint, more pain medication is needed after surgery, and physical therapy is much more difficult because they don’t have a good leg to stand on, so to speak.

Sometimes, however, there is a good reason to perform a same-day double joint replacement. For example, both arthritic knees may have a severe flexion contracture, which means they are in a bent position and the patient cannot straighten them. In such cases, it may be appropriate to do a double joint replacement, as physical therapy could be much more difficult if the non-operated knee is bent. If the contracture isn’t too severe, a shoe lift can equalize leg length and enable the patient to do physical therapy after two separate procedures.

My patient had four separate surgeries, and less than two months after her final hip replacement in May, she said she was feeling great. She believes her mental attitude and willingness to work hard in rehab after surgery played a major role in obtaining the best outcome after each joint replacement. Indeed, patients who go in with a positive attitude, work hard and put in the time in physical therapy tend to make progress more quickly and have a better recovery overall.