Bilateral Knee Replacement Cost: Both at Once or Staged?

Orthopedic Surgery · 2 · September 3, 2025

About 30% of knee replacement patients need both knees done. The question: one surgery or two? Simultaneous bilateral TKA saves 40% on total costs and puts the patient through rehabilitation only once. But it carries higher short-term risks. A 2024 JBJS study of 28,000 bilateral cases finally gave us clear data on who should — and shouldn't — have both done at once.

The Case for Simultaneous

One anesthesia event. One hospital stay. One rehabilitation period. Total cost for bilateral in India: $10,000–$14,000 vs. $12,000–$16,000 for staged (two separate hospitalizations). The 2024 JBJS data showed that in patients under 75 with ASA score 1–2 (minimal comorbidities), simultaneous bilateral TKA had identical 90-day complication rates to unilateral — 2.8% vs. 2.6%.

The Case for Staged

In patients over 75 or with cardiac/pulmonary disease, simultaneous bilateral TKA doubles the risk of requiring ICU admission (4.2% vs. 1.8%) and increases blood transfusion rates from 8% to 22%. The staged approach — 8–12 weeks between surgeries — allows the body to recover fully. Each surgery lasts 60–90 minutes vs. 2.5–3 hours for bilateral.

The Hybrid Approach

Some centers offer 'rapid staged' bilateral — both knees replaced during the same hospital admission, but on consecutive days or 3–4 days apart. This preserves the single-hospital-stay advantage while reducing physiological stress. Apollo Chennai and Max Delhi offer this protocol for patients who don't qualify for same-day bilateral.

Cost Comparison

| Country | Cost Range (Bilateral Knee Replacement)

| United States | $70,000–$130,000

| India | $10,000–$14,000

| Turkey | $14,000–$22,000

| Mexico | $22,000–$35,000

Key Takeaways

- Simultaneous bilateral TKA is safe in patients under 75 with minimal comorbidities — same complication rates as unilateral.

- Over 75 or with cardiac/pulmonary disease? Staged approach reduces ICU admission risk from 4.2% to 1.8%.

- Bilateral knee replacement in India costs $10,000–$14,000 — less than a single knee replacement in the US.

Compare real-time pricing using our global cost calculator.