Bilateral Knee Replacement in Turkey

Bilateral knee replacement is a surgical procedure in which the damaged surfaces of both knee joints are replaced with artificial joints. It is generally considered when both knees are damaged enough to affect movement and daily activities, and nonsurgical treatments, such as medications and walking aids, are no longer enough.

When both knees need to be replaced, two approaches are possible: performing the procedure in a single session under one anesthetic, or in two stages with two separate operations. No single approach has been shown to suit all patients. The surgeon and anesthesia team determine the most appropriate option after a physical examination, imaging, and assessment of the heart, lungs, kidneys, and overall health. The procedure itself is not appropriate for everyone whose knees are damaged.

This article covers bilateral knee replacement in Turkey and focuses on what is specific to replacing both knees: the difference between the two approaches, what the evidence shows, additional risks, recovery, and planning a treatment trip. The basics of the procedure, including its indications, how it is performed, and the types of artificial joints, are covered in Total Knee Replacement Surgery in Turkey.

Note: The phrase “both knees in one trip” describes the travel arrangement. It does not necessarily mean that both knees are replaced in one operation. It may mean one operation for both knees, two closely spaced operations, or two separate trips, depending on the medical team’s decision.

Key Points

• Knee replacement is considered when nonsurgical treatments are no longer enough, and the surgeon determines eligibility after examination and imaging. The procedure is not suitable for everyone.
• Both knees can be replaced in a single session (one anesthetic and one hospital stay) or in two stages (two operations under separate anesthesia).
• No approach suits everyone. Some results lean relatively toward single-session surgery and others toward staged surgery, and most of the evidence is observational and retrospective.
• Planning the treatment trip, including a companion, air travel, rehabilitation, and follow-up after returning home, is an essential part of the decision.

What Is Bilateral Knee Replacement? Single Session vs. Two Stages

Some patients call the procedure “double knee replacement” or “replacing both knees.” The medical term is bilateral total knee arthroplasty (TKA). There are two approaches:

• Single session (simultaneous replacement): Both knees are replaced under one anesthetic and during one hospital stay.
• Two stages (staged replacement): Two separate operations are performed, each under its own anesthetic, separated by days or months. Even when only a few days separate the two operations, studies classify them as staged because each has a separate anesthetic.

For this reason, it is important to ask clearly before booking: Will there be one anesthetic or two? If the procedure is staged, how long will separate the operations, and will both take place on the same trip?

Single Session or Two Stages: What Does the Evidence Show?

There is no single answer that suits everyone yet. Comparative studies show relative advantages and relative risks for each approach. The decision is individual, balancing the patient’s health, priorities, and the experience of the medical team.

This section draws on one of the recent systematic reviews and meta-analyses, published in 2025. The review pooled 42 studies including 567,915 patients. However, only one of the studies was randomized, and most of the rest were observational and retrospective, meaning analyses of past patient records. This means the groups compared may have differed in health from the start, and the results indicate trends rather than a definitive verdict.

What leaned relatively toward single-session surgery?

• Joint infection during the hospital stay was relatively lower.
• Bone fractures around the artificial joint in the first year were relatively lower.
• The need for additional operations was relatively lower.
• Operative time and hospital costs recorded in the pooled studies were relatively lower. These costs are calculated at the health-system level and do not automatically mean that a patient’s treatment package will cost less.
• No difference was seen in function, persistent pain, joint stiffness, or knee stability.

The introduction of the review notes, citing earlier studies, that single-session surgery means one rehabilitation period and a relatively shorter total hospital stay. The absence of a statistically significant difference does not prove equivalence, since studies may be unable to detect small differences.

What leaned relatively toward staged surgery?

• The likelihood of needing a blood transfusion was relatively higher, which reflects greater blood loss when two knees are operated on in one session.
• Neurological complications were relatively higher during the first year. The review’s definition of in-hospital neurological complications may include events such as stroke, delirium, and nerve disorders.
• Deaths during the first year were relatively higher. No difference was seen in in-hospital deaths or in deaths in the second year.
• Pulmonary complications were relatively higher between the first and second years.

The phrase “relatively higher” does not mean the risk is large in itself. The review’s authors noted that the absolute risk of early death remained very low in both groups.

In a large observational study comparing one knee with both knees together and with both knees in two stages, simultaneous surgery was associated with a relative increase in the risk of some complications compared with one-knee surgery. Its authors concluded that staged surgery at a short interval appears safe in carefully selected patients.

Why these results are not a final verdict

• Selection bias: Patients chosen for single-session surgery tend to appear healthier, and in many studies this group was slightly younger. These initial differences may make its results look better than they are.
• Survivorship bias: The staged group does not include patients who died or had problems after the first knee and never reached the second. This may make single-session surgery look riskier by comparison.
• Differences in protocols: The use of blood-loss-reducing medications, such as tranexamic acid, was not uniform or reported in every study, and the interval between stages varied widely.
• Rare complications: Smaller studies may not detect them.
• Blood clots: The review found no difference in the aggregate of clot events (deep vein thrombosis and pulmonary embolism) between the two approaches, unlike some older analyses that suggested a higher rate with simultaneous surgery. This is an example of conflicting evidence.

What remains unknown

• Absolute risk under current protocols: The studies span many years, and care has changed over time. No source was found that provides reliable absolute figures for modern protocols.
• The optimal interval between stages: There is no consensus, and study results vary.
• Eligibility criteria: They differ between centers, and no single validated standard suits all patients.
• Travel for treatment: The sources reviewed did not include studies of bilateral replacement in people who travel abroad for it, nor recommendations specific to air travel after bilateral replacement.

This article is based on systematic reviews and patient information pages from specialized medical societies and health institutions, and the limits of the evidence are described above. It does not replace the surgeon’s opinion.

Who May Be a Candidate for Single-Session Bilateral Replacement, and Who May Not?

Eligibility is determined after an assessment that cannot be reduced to a single number or criterion. The surgeon and anesthesia team evaluate the heart, lungs, kidneys, and overall health, and then decide whether a single session or two stages suits the patient, or whether the procedure suits the patient at all. There are no firm age or health cutoffs that apply to everyone, and criteria may vary from one center to another.

The review notes that many surgeons are cautious in selecting candidates for single-session surgery and often exclude older patients and those with significant coexisting conditions. In one large series, the risk of major complications was relatively higher for simultaneous surgery than for one-knee surgery when the whole group was considered. When patients were selected using criteria such as age and ASA class (an assessment anesthesiologists use to classify general health before surgery), the risk may be similar to that of one-knee surgery. This finding shows the importance of selection. It does not mean that any particular criterion suits everyone.

Factors the team usually considers:

• Current health: smoking, weight, and other conditions.
• Medications, including blood thinners.
• Allergies and previous experiences with anesthesia.
• The skills and preferences of the surgical and anesthesia teams.
• The patient’s priorities: one recovery or two? And the ability to tolerate having both knees painful at the same time.

May lead the team toward caution or toward staged surgery:

• Significant coexisting conditions, including heart disease and chronic lung disease such as chronic obstructive pulmonary disease, which increase the risks of general anesthesia.
• Kidney or heart disease that calls for evaluation by a specialist before surgery.
• Any condition that increases the risks of anesthesia or blood loss for the patient.

Who May Be a Better Candidate for Two-Stage Surgery?

Staged surgery spreads the risk across two operations and allows the patient to recover from the first knee before the second. But it means two anesthetics and two recoveries, cumulative exposure to the risk of infection, and some patients may not complete the second stage.

The most suitable interval between stages is not agreed on. The interval varied widely between studies, which makes comparison difficult. In a network meta-analysis published in 2025, intermediate intervals, neither very short nor very long, were associated with a relative reduction in the risk of death and complications. The findings are largely observational. In contrast, the observational study mentioned above found that a short interval appears acceptable in selected patients. Neither can be relied on to determine the interval for an individual patient, and the decision is left to the treating surgeon.

A patient traveling to Turkey for treatment should ask the team early: How long will separate the two operations? Will both take place on the same trip? What if recovery is delayed after the first? And does that mean a longer stay or two trips?

Evaluation Before Deciding

A good evaluation begins with the surgeon’s examination and includes:

• Medical history and physical examination (knee motion, stability, strength, and leg alignment).
• X-rays, and sometimes additional tests such as magnetic resonance imaging (MRI) or blood tests.
• Discussion of other options, such as medications, injections, and physical therapy.

The following may also be requested:

• A general medical examination and blood and urine tests.
• An electrocardiogram (ECG).
• A review of medications and supplements.
• Completion of major dental work before surgery to reduce the risk of infection.
• Evaluation by a heart or kidney specialist for patients with chronic disease in either.

The anesthesia team discusses the appropriate type of anesthesia with the patient. It is best if the decision between a single session and two stages is the result of this evaluation, not made before it.

What to prepare before traveling for a consultation: previous imaging and test reports, a list of medications and allergies, previous operations, and any cardiac or chest reports.

Questions to Ask Your Surgeon Before Deciding

• Do you consider my case suitable for a single session or for two stages, and why?
• What heart, lung, and kidney evaluation is needed before deciding?
• What is your plan to limit blood loss, and are the necessary resources available if I need a blood transfusion?
• Is intensive monitoring available after surgery if needed?
• What type of anesthesia do you propose for my case?
• Who supervises rehabilitation in the hospital, and when will I start moving?
• If we choose two stages, how long will separate them, and will both take place on the same trip?
• What determines whether I am ready to travel after surgery?
• What happens if I need an extended stay or intensive care?
• How do I reach you after I return home, and what warning signs should prompt me to call right away?

Additional Possible Risks of Bilateral Replacement

The known risks of joint replacement apply to both knees, chiefly blood clots in the veins, infection, and nerve or blood vessel injury. What is specific to bilateral replacement is covered in detail in the evidence section and is not repeated here. Practical considerations add to it:

• The patient has no healthy leg to rely on early in recovery, so reliance on help increases.
• The possibility of needing later surgery remains with any joint replacement. Causes include deep infection, wear or loosening of the artificial joint components over time, or stiffness that does not improve with physical therapy.

Measures to prevent blood clots usually include early movement of the foot and ankle, support stockings or compression devices, and blood-thinning medication for a period set by the surgeon.

The doctor should be notified immediately if any of the following appears:

• Increasing leg pain, redness and tenderness above or below the knee, or new or increasing swelling in the leg, ankle, or foot.
• A persistent fever or chills, increasing redness or swelling of the wound, drainage from it, or increasing knee pain.

If sudden shortness of breath or sudden chest pain occurs, do not wait for an appointment. Seek urgent medical help.

Recovery After Bilateral Knee Replacement

The major medical sources describe recovery after one knee, and no documented timeline specific to both knees was found in what was reviewed. General principles are therefore presented here, and timelines are left to the treating team.

General principles:

• Physical therapy usually begins within hours of surgery, followed by a gradual walking program and repeated exercises to regain motion and strength.
• Crutches or a walker are used at first. The surgeon and physical therapist decide which aid is appropriate and when it can be stopped.
• Compression stockings are worn as the team directs, and the leg is elevated to reduce swelling.
• Deep-breathing exercises in the first days help prevent pneumonia, and nursing staff may provide a breathing-measurement device (an incentive spirometer) for this purpose.
• Falls should be avoided in the first weeks, as they can damage the new joint and require additional surgery.
• Full recovery may take several months or longer and varies with age and general health.

What may differ with two knees?

• With no healthy leg to lean on, more help is needed in the first weeks, and the patient usually needs someone to assist with cooking, shopping, bathing, and laundry.
• In a single-center study, same-day bilateral replacement did not increase hospital returns during the follow-up period. However, its patients were relatively more likely to be discharged afterward to a care or rehabilitation facility. Its group was also younger and in better general health by ASA class than the staged group. It is reasonable to ask in advance whether a rehabilitation stay may be needed.

Preparing the accommodation or home:

• Handrails or secure grab bars in the bathroom and on stairs, and a stable shower seat.
• A firm chair with armrests and a footrest to elevate the leg.
• A raised toilet seat with handles if the toilet is low.
• Removal of loose rugs and cords.
• A living space on one floor, where possible.

Planning Your Treatment Trip to Turkey

Before traveling

It is advisable to request an initial consultation and send medical reports, and to review the questions above. To learn about available medical facilities, see our page on Orthopedic and Joint Surgery Hospitals in Turkey. The final choice depends on the patient’s condition and the medical team’s assessment.

Length of stay and return

No fixed duration is given, as it depends on mobility, the absence of complications, and the surgeon’s decision. The criterion the sources give for leaving the hospital after one-knee replacement is the absence of signs of complications and the patient’s ability to move around safely with crutches. A short stay in a care facility may also be decided depending on the case. It is advisable to book the return date flexibly and not to confirm it until the surgeon approves the patient’s readiness.

Air travel after surgery

Sources differ and there is no consensus on timing. The American Association of Hip and Knee Surgeons (AAHKS) states that several studies have found early travel to be safe for most patients if precautions are taken, and that most people feel comfortable traveling within a few weeks. It also notes that patients with higher risk factors for blood clots should discuss their travel plans with their doctor and surgeon before surgery, and that this may affect the choice of preventive medication.

In contrast, the Royal Orthopaedic Hospital in Birmingham, an NHS hospital, recommends in its patient page waiting three months after hip or knee replacement before journeys longer than four hours, and informing the surgeon of travel plans. This is the recommendation of one specific hospital, not national guidance or the general position of the NHS. Neither page addresses bilateral replacement specifically.

For this reason, no fixed date is given. The surgeon decides based on the condition of the wound, mobility, clot risk, and length of the journey.

General precautions mentioned in the sources:

• Wearing compression stockings or using compression devices, and taking preventive medication as prescribed by the doctor.
• Walking and moving regularly, about every one to two hours, along with leg and ankle exercises and ankle circles.
• Drinking plenty of water, avoiding alcohol and coffee, and avoiding tight clothing.
• Informing the surgeon and the travel company about the recent surgery, and discussing travel plans with the surgeon before the operation.
• Expecting some extra pain or swelling, and bringing or arranging a cane or walker for arrival.

It is also possible to ask the airline about airport assistance services.

Companion and accommodation

It is advisable to travel with a companion who is able to help, and to choose accommodation that is easy to move around in, on the ground floor or with an elevator, with a suitable bathroom and a shower seat.

Follow-up after returning home

The patient needs regular follow-up and X-rays as the surgeon directs. Stitches or staples are removed after a period determined by the surgeon, so the patient should ask who will take care of this if returning home before then. Before traveling, it is advisable to obtain:

• A written report on the surgery, medications, and instructions.
• The required rehabilitation program.
• A way to contact the team.

It is also advisable to tell the dentist about the artificial joint, as the surgeon may decide to give preventive antibiotics before some dental procedures.

Estimated Cost of Bilateral Knee Replacement in Turkey

O9 Medical estimates the initial cost of bilateral knee replacement in Turkey at between $12,000 and $18,000 (USD), depending on the type of artificial joint used, the surgical approach (single session or two stages) and the hospital stays it entails, the length of stay, and the services included in the package. This is a preliminary, non-binding estimate, and the final price is determined after medical reports are reviewed and the patient’s condition is assessed.

Other factors that may affect the price:

• Fees of the surgeon and anesthesia team.
• Tests before and after the operation.
• The need for a blood transfusion or intensive monitoring.
• Physical therapy and rehabilitation sessions.
• Accommodation for the patient and companion, and transportation.
• Follow-up and X-rays.
• A second trip if surgery is staged.

Questions about the package:

• What exactly does the price include: consultation, tests, surgeon, anesthesia, hospital, medications, and follow-up?
• What does it not include?
• Does it include accommodation and physical therapy sessions?
• What if the patient needs an extended stay or intensive care?
• Do the agreed fees cover any complications?

How O9 Medical Helps

O9 Medical helps patients understand their options, arrange communication with the medical team, and prepare the required reports, and helps them ask the right questions before making a decision. It does not guarantee results and does not replace the surgeon’s assessment, which determines what suits each patient. To learn about our services in this field, visit Orthopedic and Joint Surgery in Turkey, or get in touch through the contact options available on the website.