OBJECTIVE To investigate the principle and methods of preoperative and postoperative rehabilitation for simultaneous bilateral total knee arthroplasty. METHODS From January 2005 to June 2008, 72 patients (144 knees) were reviewed in the study, including 33 males and 39 females, ranging in age from 46 to 78 years, with an average age of 69 years. There were 54 patients with osteoarthritis, 17 patients with RA, and 1 patient with traumatic osteoarthritis, including 10 cases (15 knees) of fixed varus deformity more than 30 degree and 6 cases (8 knees) of fixed vagus deformity more than 15 degree. Rehabilitation protocol was made for preoperative, early postoperative and late postoperative stages. Patients were encouraged to initiate the exercises at the early postoperative stage on the premise of multimodal analgesia. Knee function and pain were evaluated using WOMAC and VAS pain scores. Lower limb embolism was determined by ultrasonic scan and pulmonary embolism was diagnosed by clinical manifestation and D-dimer level. RESULTS Sixty-nine patiets (138 knees) were followed up at 2 d preoperatively and the second day, 1, 2, 8 and 24 weeks postoperatively. The average postoperative WOMAC and VAS score were significantly lower than preoperative levels,while the postoperative knee ROM and 6 min walking distance were evidently higher than the preoperative ones, respectively. One hundred and twenty-eight knees achieved full extension and flexion more than 90 degree at 2 weeks postoperatively, and 135 knees reached 110 degree in flexion. Unilateral lower limb embolism was found in 2 cases (2 knees) and bilateral ones were found in 1 case (2 knees). No pulmonary embolism was confirmed. CONCLUSIONS Rehabilitation protocols should be made for preoperative, early postoperative and late postoperative stages of simultaneous bilateral knee arthroplasty. Patients should be encouraged to exercise at the early postoperative stage on the premise of multimodal analgesia, in order to improve knee function and reduce edema.