Last reviewed: September 29, 2026

Usually about the same in the end. Some people find the first days harder the second time, and the improvement can feel smaller.

When both knees are replaced in separate operations, most people end up with two knees that work about equally well. Many studies found the second knee improved less, but largely because it was less painful to begin with. Satisfaction was about the same for both.

The hospital stay is often slightly shorter the second time, and people more often go straight home. Several small studies found more pain after the second knee, especially when the operations were close together. A larger study found no difference. One large study found more emergency visits after the second operation, mostly for infection, with no difference in redo operations.

How the first knee went is the best guide to the second. A complication after the first knee made one after the second more likely. Still, in one study about three in four people who were unhappy with their first knee were satisfied with their second.

About one in five people planning a second knee do not go ahead within two years. The most common reasons were a slow recovery or a poor experience with the first knee, though some found the other knee had improved enough. Those who stopped had done less well with the knee they had.

At least six weeks between operations is linked to fewer complications. Beyond that, the best gap is not known. One study found women improved less with the second knee than with the first.

In general:

  • If both knees need replacing, ask your surgeon whether one operation or two suits you.
  • Tell your surgeon how the first recovery went, including anything that worried you.
  • Ask how pain will be managed the second time.
  • If the other knee has improved since the first operation, say so before scheduling.

Drafted with AI assistance from published sources, reviewed and edited by Babak Sheikh, MD.

Sources:

  • Lewin AM, et al. First Knee for Pain and Function Versus Second Knee for Quality of Life. Bone Jt Open. 2024. https://doi.org/10.1302/2633-1462.53.BJO-2023-0035.R1
  • Abram SGF, et al. Patient Reported Outcomes in Three Hundred and Twenty Eight Bilateral Total Knee Replacement Cases (Simultaneous Versus Staged Arthroplasty) Using the Oxford Knee Score. Int Orthop. 2016. https://doi.org/10.1007/s00264-016-3122-6
  • Malahias MA, et al. Different Clinical Outcomes on the Second Side After Staged Total Knee Replacement. A Systematic Review. The Knee. 2019. https://doi.org/10.1016/j.knee.2019.04.011
  • Clement ND, et al. Asynchronous Bilateral Total Knee Arthroplasty: Predictors of the Functional Outcome and Patient Satisfaction for the Second Knee Replacement. J Arthroplasty. 2019. https://doi.org/10.1016/j.arth.2019.06.056
  • Singh M, et al. Pulling the Trigger Sooner: Patients Pursue Subsequent Contralateral Total Joint Arthroplasty With Lower Preoperative Pain. J Am Acad Orthop Surg. 2026. https://doi.org/10.5435/JAAOS-D-25-01058
  • Schwarzkopf R, et al. Outcomes of a First Total Knee Arthroplasty Are Associated With Outcomes of the Subsequent Contralateral Total Knee Arthroplasty. J Arthroplasty. 2020. https://doi.org/10.1016/j.arth.2020.01.037
  • Kim MH, et al. Comparison of Postoperative Pain in the First and Second Knee in Staged Bilateral Total Knee Arthroplasty: Clinical Evidence of Enhanced Pain Sensitivity After Surgical Injury. Pain. 2014. https://doi.org/10.1016/j.pain.2013.08.027
  • Sun J, et al. Analysis of Early Postoperative Pain in the First and Second Knee in Staged Bilateral Total Knee Arthroplasty: A Retrospective Controlled Study. PLoS One. 2015. https://doi.org/10.1371/journal.pone.0129973
  • Chadayammuri VP, et al. Postoperative Pain and Opiate Requirement Is Increased Following Second-Side Surgery Among Patients Undergoing Staged Total Knee Arthroplasty. Arthroplast Today. 2024. https://doi.org/10.1016/j.artd.2024.101591
  • Bieganowski T, et al. Opioid Consumption and Mobilization in Staged Bilateral Total Joint Arthroplasty: Did We Learn Our Lesson the First Time? J Arthroplasty. 2024. https://doi.org/10.1016/j.arth.2023.06.025
  • Khury F, et al. Evaluating the Optimal Timing Between Staged Bilateral Total Knee Arthroplasties for Improved Clinical Outcomes. J Arthroplasty. 2026. https://doi.org/10.1016/j.arth.2026.01.023
  • Longstaffe R, et al. Outcomes and Motives for Not Proceeding With the Second Stage Bilateral Knee Replacement: A Comparison of Cancelled and Completed Bilateral Total Knee Arthroplasty. Can J Surg. 2023. https://doi.org/10.1503/cjs.008621
  • Agarwal AR, et al. Interval Time of at Least 6 Weeks Between Bilateral Total Knee Arthroplasties Is Associated With Decreased Postoperative Complications. J Arthroplasty. 2023. https://doi.org/10.1016/j.arth.2022.12.037
  • Tucker A, et al. Are Patient-Reported Outcomes the Same Following Second-Side Surgery in Primary Hip and Knee Arthroplasty? Bone Jt Open. 2021. https://doi.org/10.1302/2633-1462.24.BJO-2020-0187.R1

This is general information about what published research shows. It is not medical advice and it is not about your situation. Reading it does not create a doctor-patient relationship with me. I am a retired orthopedic surgeon and I do not see patients. Talk with your own doctor before changing anything about your care. If something feels suddenly or seriously wrong, get medical care promptly rather than waiting.

This page is provided as is. I make no guarantee that it is accurate, complete or current, and medical evidence changes. Use of it is at your own risk.

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