Doubling up: Knee replacement surgeries and the pros and cons of a double knee surgery
If you have ever had an issue with your knee, you know how it can impact your daily life and limit your mobility. It can even be debilitating. If the problem is severe enough, a knee replacement is needed. But what do you do if your condition requires a “double” knee replacement? Dr. Daniel Wagner is a board certified orthopedic surgeon at Texas Hip & Knee, a part of Texas Health Physicians Group. He’s on the medical staff at Texas Health Southwest Fort Worth. In addition, he is on the medical staff at Texas Health Hospital Clearfork, which is a destination orthopedic hospital location that is part of Texas Health Southwest Fort Worth.
Recently we sat down with Dr. Wagner to get some advice on how to know when it’s time for surgery. It can be tough to know, but a clear indicator is when you can’t spend time doing the things you love.
Q: Are there any nonsurgical solutions to a knee injury?
A: Oh yes, we try those in the beginning and we exhaust those until there’s no other option. We start with rest, ice and elevation. Ice works really well to decrease swelling and heat can actually work well too to stretch out tight muscles and relax tendons. Anti-inflammatory medications can also be used to help control the pain and allow for a little more activity and sometimes we do steroid injections and that can help decrease the inflammation in local joints – especially the knees. There’s a type of injection called visco supplementation that’s a single shot or a series of shots that you usually do about a week apart that can give long-lasting relief to patients who are trying to avoid surgery.
Q: How long is ‘long lasting’?
A: Sometimes it can be six months or a year. Every patient is different, but a lot of times trying a shot is easier than trying surgery.
Q: I’m assuming you see patients who are experiencing pain in one knee, but find out they actually need double knee replacement. How is that determined?
A: We do a physical exam that includes comparing one knee to the other and sometimes we’ll find limitations of one joint versus both joints. Then we get a set of X-rays and those X-rays can tell us what the joint looks like. Sometimes folks will have arthritis in both joints, but the one they come to see me about actually looks better than the X-ray of the other one. But the other one doesn’t hurt, so it’s always interesting to go over that with them.
Q: Sometimes people end up favoring the knee they don’t feel pain in – does that affect the other knee?
A: Yes, sometimes people will overcompensate from an injury or a twist and put all their pressure on the other joint and that becomes sorer as well. A lot of times if we fix the painful one, the other one will get better!
Q: So when a double knee replacement is needed, are they done simultaneously or are those done one at a time?
A: There are different ways to do it. Sometimes, on occasion, with my partners at Texas Hip & Knee Center, we may do them simultaneous, meaning two surgeons working on one patient at one time. Most of the time it’s one surgeon working on both knees – one and then the other – at the time of surgery. It depends on circumstances and schedules.
Q: Talk a little about the differences between a single knee replacement and a double in terms of recovery time and how long the actual surgery is typically.
A: For a single knee replacement, the surgery takes about an hour, then we get them up and walking the same day after surgery with physical therapy. They’ll sit in a chair for an hour or two. The next day, they’ll get right back up and continue physical therapy and a lot of times go home that day. Then physical therapy will go to their homes and continue working with them for two to four weeks after surgery. They can put weight on it as they feel comfortable. We usually have them use a walker at first, then a cane and get off that as soon as they feel comfortable. They can usually drive somewhere between two and four weeks after surgery. With double knee surgery, surgery takes about three hours. We still try to get patients up that same day, but because it takes a little longer and it’s a longer anesthetic, usually they’re in the hospital for two days. Sometimes they are required to go to a rehab unit for help since they don’t have a good leg to stand on. Their activity is going to be more limited at first too.
Q: How long do you have to wait between knee surgeries if you need to get both done, but you do them one at a time?
A: A lot of times that’s up to the patient. Most commonly it’s about six weeks, but that can look more like three months. Some patients are eager to get them both done. But some patients have to work with family and neighbor support to help them out once they’re home so they don’t go into an unsafe situation.
Q: Texas Health Hospital Clearfork is a destination orthopedic hospital focusing on not just knee replacements, but hip replacements, too. What does destination orthopedic hospital mean?
A: Texas Health Clearfork is a beautiful facility with large ORs that can accommodate visitors when we have other doctors who come in to see procedures or we have medical students who sometimes rotate with us. We also have a nursing program that will have specialized training in joint replacement. We try to make it so families are comfortable in the rooms. We have suites that have almost separate bedrooms for families so they’re not awakened by some of the noises of the hospital. And we try to make the food pretty good too!
Q: Are you seeing younger and younger people needing knee replacement surgery?
A: Absolutely. People are more active – they’ve been harder on their knees growing up. I see a lot of flag football leagues, intermural leagues, etc. with injuries and those injuries have long-term effects. A knee replacement surgery can restore a more active lifestyle for young, healthy patients.
Q: What other advice would you give someone who is facing a knee replacement surgery?
A: It’s a marathon and not a sprint. Do your exercises and your stretches in physical therapy. If you think it’s going to automatically get better, you have to remember you have to do some work too and you have to work through some of the pain. As you loosen up the joints it gets better and it feels better the more you do!
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Doctors on the medical staff practice independently and are not employees or agents of the hospital.