Guidelines for multiple joint replacements

Some people may need to have more than one joint replaced-for example, a shoulder and an elbow, a shoulder and a knee, both knees, or a hip and a knee. Doctors have different opinions about what is best, based on their experience and your specific situation. Your doctor will consider many factors, but the following are some general guidelines.

• If you need both a shoulder and an elbow replaced, your doctor will probably replace the more painful and disabling joint first.
• If you need a shoulder and either a hip or knee replaced, your doctor usually cannot replace the hip or knee until at least 3 months after the shoulder. This is to give the shoulder time to heal before you need to use crutches or a walker after the surgery on your hip or knee.
• If you need both a hip and a knee replacement, and you are not sure how well you will tolerate rehabilitation (rehab), most doctors will recommend having surgery on the hip first. Recovery after hip surgery doesn't require as much rehab, so if you do well, you may also do well with the more intensive rehab required after knee surgery.¹
• If both knees or both hips need replacement, some doctors recommend doing both knees or hips at the same time during the same surgery. Others may recommend doing two separate surgeries during a single hospital stay.
• If you need hip and knee replacement surgery on the same leg, doctors will usually replace either the most painful joint or the hip first. There are two reasons for this:²
  • Pain from arthritis in the hip joint can spread to the knee (referred pain). Replacing the hip first gives you a better idea how much of your knee pain is actually from arthritis in your knee.
  • The hip surgery usually is done first because a painful knee will not interfere too much with successful rehab after hip surgery. On the other hand, a painful hip may interfere with successful rehab after knee replacement surgery.
• If you do have two surgeries at the same time or very close together, your recovery is likely to take longer than if you had a single surgery. However, it is still likely to be shorter than the total recovery time for one surgery and recovery followed by a separate surgery and recovery.

Citations

1. Sledge CB (2005). Introduction to surgical management of patients with arthritis. In ED Harris Jr et al., eds., Kelley's Textbook of Rheumatology, vol. 2, pp. 1829-1835. Philadelphia: Elsevier Saunders.

2. Sledge CB (2005). Principles of reconstructive surgery for arthritis: The hip. In ED Harris Jr et al., eds., Kelley's Textbook of Rheumatology, 7th ed., vol. 2, pp. 1876-1888. Philadelphia: Elsevier Saunders.