The Baltimore Sun, "More doctors accepting simultaneous knee surgeries"

Published April 24, 2015

Dr. Nicholas Grosso

More doctors accepting simultaneous knee surgeries

By Andrew K. McDaniels

Sandra Lynch tried steroid shots and physical therapy to cure her ailing knees, but finally her doctor said enough: The 62-year-old wedding officiant from Frederick needed surgery to get them both replaced.

Lynch dreaded the thought of two surgeries and a long recovery. But her doctor suggested an option that he said would make the experience more bearable.

Two doctors would perform the surgery on both of her knees at the same time.

It would take just four months for both knees to heal, rather than getting one knee replaced, recovering for four months and then going through the same process on another knee.

Another alternative would have been to have one doctor fix both knees on the same day, but that would have doubled the time in the operating room while increasing the risk of complications.

"My happiest patients are the ones who have both knees done," said Lynch's doctor, Dr. Nicholas Grosso, president of the Centers for Advanced Orthopaedics, with offices throughout the Mid-Atlantic. "They have a tough few weeks of recovery, but after that they're really happy."

Lynch agreed to the simultaneous knee surgery and said she was happy she did. The recovery was more painful than she ever imagined. She cried when she tried to bend her new knees for the first time during physical therapy.

"Walking is not the hard part," she said. "The hard part is sitting down and standing up, because your knees just don't bend."

She's not sure she would have been able to go through two separate knee surgeries.

"I can't imagine going through the pain I went through a second time," Lynch said. "No, no, no. I am so glad I just had to have one surgery."

Simultaneous knee surgery is not new, but some doctors were concerned about the potential complications from performing two surgeries at the same time. But research has increasingly shown that it is no more dangerous than traditional knee replacement surgeries.

A study by researchers at the Indiana University School of Medicine that looked at simultaneous knee surgeries around the country found that the outcomes were no more dangerous, if not better, than replacing a person's knees on separate occasions. The researchers looked at what is called a "knee society score," which takes into account factors such as the patient's ability to walk after the surgery. They found a patient's range of motion was better after simultaneous knee surgery.

It can also be more cost-effective to do the simultaneous surgery because hospital stays are shorter, said Dr. Deren Bagsby, one of the researchers and a resident in the orthopaedics department at Indiana.

The downside is twice the pain for a small amount of time.

"In motivated patients who know it will be tough and can handle the pain and rehab, it can be a good option," Bagsby said.

The surgery is also good for people who have bowed legs, knock knees or some other deformity. Doing just one knee would leave one leg impaired and make it hard to walk.

People who can't take a lot of time off from work are also good candidates for the simultaneous knee surgery.

There are complications, just as with most surgeries: blood clots, infection, bleeding problems.

And some people just aren't good candidates for the surgery. Grosso said he looks at a patient's level of risk, such as pre-existing heart disease and age.

Lynch's knees had been deteriorating progressively for decades. The kneecap on the right was bone on bone, she said. The left leg also was in bad shape.

She had her surgery in December and after three months was done with physical therapy. She wasn't able to do much this winter, but is ready for next year with her new knees.

"Next winter it will be better and I will go out and shovel snow — and maybe learn to ski," Lynch said.

amcdaniels@baltsun.com

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