• It's fairly common
for patients to have
symmetrical arthritis
in both knees, more
common than it is with
hips. When you're
dealing with 2 equally
bad knees, you have 3
options. One is to
stage 2 operations
about 3 months apart.
Another is to do them
during the same hospi-
tal stay, usually about 5
days apart. The third option is to take care of both in one operation. In
my experience, patients overwhelmingly prefer to go through one opera-
tion and not have to repeat the whole procedure and recovery again.
They want to get both knees done at once and begin to move on.
• With one operative procedure, there's just one anesthetic and you
have symmetrical recovery. But if you fix just one knee, and you have
a bad knee on the other side, you delay the recovery of the newly
replaced knee. Many patients have flexion contractures in both knees,
meaning they can't completely straighten either. When you operate on
one, the newly replaced knee always takes on the posture of the bad
knee. Patients often lose the correction because they can stiffen up in
that flexed position.
• It's less costly to the healthcare system to do 2 knees at once than
to do them separately (about $67,000 vs. $90,000). Of course, it's also
less lucrative for the surgeon, because CMS pays full price for the first
knee and only half for the second, but that's a price I'm willing to pay
9 0 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • O C T O B E R 2 0 1 7
• MOTIVATED AND MOBILIZED Dr. Sculco prefers to do bilateral total knees first thing in
the morning. By day's end, patients are usually ready to stand and take a few steps.
