Though not common, sometimes patients will have arthritis of both the hip and the knee. This can be a bit confusing as often hip pain can radiate towards the knee and give the patient the impression that their knee is bad. It is important that a thorough evaluation of both the hip and knee be carried out with a careful history, physical examination, and radiographs or x-rays of both the hip and the knee. If in fact arthritis is present in both, patients commonly ask which they should do first. If the symptoms are fairly equal and the x-ray evidence of arthritis is similar, most orthopedic surgeons would recommend repairing the hip first for several reasons.
Replacement of the hip joints takes about the same amount of time as replacement of the knee joint but the recovery from the operation is felt by most patients to be easier after hip replacement. This is because most often after a hip replacement, the patient can put all of their weight on the hip after a period of support using crutches or a walker and then relatively quickly advancing to a cane. Therapy involves learning how to walk appropriately after the joint replacement and working on strengthening exercises. Patients are often surprised that the pain they have after surgery quickly becomes less then the pain that they had prior to surgery from arthritis.
Knee replacement, again, is a relatively straight forward operation but the recovery is felt my most patients to be more demanding because of the need to not only work on their walking but also the importance of range of motion exercises and reestablishing a normal or near-normal arc of motion in their knee. Getting full extension or straightening of the knee and flexion past 115° requires hard work and diligence on the part of the patient. These range of motion exercises are often felt to be quite uncomfortable by the patient and therefore, patients who have had both a hip and knee replacement will typically tell you that the knee required more work but in the end, the results of hip and knee replacement are very similar with approximately 90% successful satisfactory outcomes.
Sometimes, patients will ask if they can have both done at the same time and while this is commonly done with bilateral hip replacement or bilateral knee replacement, combining a hip and a knee on the same extremity often seems quite challenging to a patient.
