By John Hogan
At first take, getting two total knee replacements at once sounds insane. But I decided it would be best for me.
I found no relevant first-hand experience from any brave souls who actually went through bilateral total knee replacement (B-TKR), especially as it pertains to serious road cyclists. The goal of this article, then, is to share the highlights of my experience and to include advice that will make your recovery faster should you elect to have B-TKR.
First, some background on me. I have been an avid road biker for 37 years. I am a 73-year-old and did not want to waste two years recovering from two separate knee surgeries. I really dreaded getting this done, and before making the decision I tried steroid injections (great for a while), Synvisc injections (almost useless), and lost weight to reduce the load on my knees. But knee pain began to dominate my life. Walking down steps and down modest grades became very painful. I had to do something, and that something was B-TKR.
Disadvantages of B-TKR
In my opinion, B-TKR has two major disadvantages when compared with a single TKR:
1. Clotting risk is higher since two knees are being replaced during one procedure.
You can minimize the clotting risk by picking the right surgeon. Risk for clotting is highest during the tourniquet phase of the procedure. It is important to keep tourniquet time short. The surgeon I used keeps this time under 8 minutes per knee. I will give some other guidelines for picking a surgeon later in this article.
2. Recovery during the first 2 weeks is more difficult since you do not have a “good” leg for mobility and balance.
My original plan was to go home after release from the hospital and use in-home physical therapy. With a single-knee TKR, you should be able to head home in 2 days or less with no problem. At the end of my three-day hospital stay, I could handle a walker on the flats, but I was in absolutely no shape for stairs (I live in a 2-story house).
In fact, this was the low point of the entire knee replacement experience. The solution was to move directly into a skilled nursing facility with a strong physical therapy unit for a week. “Skilled nursing” sounds horrible, but trust me, if you pick the right facility, it is great. In my case I received physical therapy twice a day for seven days. That made a huge difference: at the end of my seven-day stay I was ready to go home and start out-patient physical therapy.
1. Pick the best surgeon you can find. Travel if necessary. Make sure the doctor has a stellar reputation and performs bilateral knee replacements routinely. Volume is a very important indicator: the surgeon should average at least 10 replacements a week. The entire surgical team is important, as well as the hospital that manages the surgical facility. If you live in or near the Charlotte, North Carolina, area, I highly recommend Dr. John Masonis of OrthoCarolina. He is absolutely outstanding.
2. Make sure the hospital’s infection rate is super low. Infections in a replacement joint are very difficult to treat and will set you back months in recovery.
3. I am an advocate of the custom-fit replacement joint (Google “Conformis” for more information). Not only do you recover faster, but the surgeon has precise cutting guides for fitting the knee replacement to the bone. This eliminates the most common cause of replacement joint problems/failures – bad surgical fit.
4. Train for your surgery. It is a big event. Go in with strong quads (usually not a problem for a cyclist) and strong upper body. After surgery, you will be doing lots of pushing off chairs and handrails. Push-ups are an ideal upper body exercise.
5. Research skilled nursing facilities in your area. Make sure the facility has a 5-star Medicare (federal) rating. You want an excellent physical therapy unit, spotlessly clean room and, being a cyclist, good food. If you have your B-TKR done in the Charlotte area, I highly recommend Sharon Towers.
6. Once you are discharged from the nursing facility, start out-patient sports rehab. Sports physical therapists are more aggressive and they are a better match for the serious cyclist. Don’t settle for in-home therapy because they lack the equipment and cannot provide the same level of care.
I was most interested in how long it would take to drive and, of course, get back on the bike. After just 2 weeks you start to hit milestones that make real improvements in your daily life.
- After 2 weeks I was able to transition from a walker to a cane. That is a big deal because a cane is more natural to use.
- After 3 weeks I really didn’t need a cane except where there were obstacles such as curbs and uneven surfaces.
- Pedaling with both legs was slow to happen for me. You need at least 105 degrees of bend and one knee was slower to get there. I started off pedaling one leg at a time on a stationary bike (about 2 weeks) and worked up to both legs (about 3.5 weeks).
- After 4 weeks I could drive. The hardest part for me was just getting my legs into the car; the actual driving was no problem.
- My first day out on the bike was 6 weeks, 5 days after surgery. It was just a 5.4-mile ride in the neighborhood at a blazing 15.4 mph average, but in spite of that, it was a great day. No joint pain, but my quads were weak from atrophy.
- Improvements happen quickly once you get back on the bike. After two weeks I slowly increased my distance up to 13 miles and average speed has improved to 17.6 mph. Nothing to brag about, but I am just 8 weeks, 5 days post-surgery. I anticipated more like 12 weeks to reach this point.
The first two weeks of bilateral TKR recovery are the most difficult, but it was not as bad as I anticipated. My guess is that after two to three weeks, there is no big difference in recovering from a bilateral total knee replacement versus a single total knee replacement. Also, pain is pain. You can only hurt so much, so why not get it over with in one shot?
That said, is bilateral knee surgery the best choice for everyone?
No, of course not. You need to be in good physical condition with no serious risk factors (diabetes, etc.) and atthe proper weight. Fortunately, most of you reading RBR Newsletter with two bad knees are in good shape and would be good candidates for bilateral knee surgery.
I went into this very prepared except for anticipating the need for a one-week stay in a rehab facility. If you do elect bilateral knee surgery, I hope my sharing some of my experience will help you sail through.