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Peri-operative Morbidity Associated with Bilateral Hip Arthroplasty for Inflammatory Arthritis: Results from a Consecutive Series of 168 Hips

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Abstract

Aim

This study aims to assess the risks and peri-operative morbidity associated with a single-stage sequential bilateral hip arthroplasty (SBHA) when performed in patients with arthritis secondary to inflammatory arthropathy.

Methods

Data of patients who underwent SBHA between 2012 and 2018 for inflammatory arthritis were extracted from a database, for peri-operative complications and functional improvement. SBHA for other causes was excluded.

Results

Data of 84 consecutive patients with a mean age of 34.5 years were analyzed. The mean follow-up was 2.4 years. 66% had ankylosing spondylitis, while 14% had rheumatoid arthritis. 50% of the patients had bilateral fusion of the hips, and 34% had flexion deformity > 30°.

None of the patients had peri-operative cardiac or pulmonary complications. 2.4% had per-operative hypotension (MAP < 50 mmHg) and 1.2% had desaturation (SpO2 < 90%). The mean drop in hematocrit was 9.3%. While 31% did not require blood transfusion, 35% required more than 1 unit of blood. Patients with pre-operative PCV of > 36% had a significantly lower risk of being transfused > 1 unit of blood (p = 0.02). ICU admission was 6%—mostly for post-operative monitoring. While one patient had a local hematoma that needed a wash-out, there were no infections, dislocations, or mortality in these patients. The modified Harris hip score improved from a mean of 26.5–85. The mean hip flexion improved post-operatively from 32° to 92°.

Conclusions

SBHA for inflammatory arthritis can be performed with minimum complications in a multidisciplinary setting. Pre-operatively, PCV of > 36 is advised to reduce transfusion rates.

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References

  1. Calabro, L., Yong, M., Whitehouse, S. L., Hatton, A., de Steiger, R., & Crawford, R. W. (2020). Mortality and implant survival with simultaneous and staged bilateral total hip replacement: Experience from the Australian Orthopedic Association national joint replacement registry. Journal of Arthroplasty, 35(9), 2518–2524.

    Article  Google Scholar 

  2. Aghayev, E., Beck, A., Staub, L. P., et al. (2010). Simultaneous bilateral hip replacement reveals superior outcome and fewer complications than two-stage procedures: A prospective study including 1819 patients and 5801 follow-ups from a total joint replacement registry. BMC Musculoskeletal Disorders, 11, 245.

    Article  Google Scholar 

  3. Romagnoli, S., Zacchetti, S., Perazzo, P., Verde, F., Banfi, G., & Viganò, M. (2013). Simultaneous bilateral total hip arthroplasties do not lead to higher complication or allogeneic transfusion rates compared to unilateral procedures. International Orthopaedics, 37(11), 2125–2130.

    Article  Google Scholar 

  4. Rasouli, M. R., Maltenfort, M. G., Ross, D., Hozack, W. J., Memtsoudis, S. G., & Parvizi, J. (2014). Perioperative morbidity and mortality following bilateral total hip arthroplasty. Journal of Arthroplasty, 29(1), 142–148.

    Article  Google Scholar 

  5. Houdek, M. T., Wyles, C. C., Watts, C. D., et al. (2017). Single-anestheticversus staged bilateral total hip arthroplasty: A matched cohort study. Journal of Bone and Joint Surgery, 99(1), 48–54.

    Article  Google Scholar 

  6. Glait, S. A., Khatib, O. N., Bansal, A., et al. (2015). Comparing the incidence and clinical data for simultaneous bilateral versus unilateral total hip arthroplasty in New York State between 1990 and 2010. Journal of Arthroplasty, 30(11), 1887–1891.

    Article  Google Scholar 

  7. Berend, M. E., Ritter, M. A., Harty, L. D., et al. (2005). Simultaneous bilateral versus unilateral total hip arthroplasty an outcomes analysis. Journal of Arthroplasty, 20(4), 421–426.

    Article  Google Scholar 

  8. Blizzard, D. J., Penrose, C. T., Sheets, C. Z., et al. (2017). Ankylosing spondylitis increases perioperative and postoperative complications after total hip arthroplasty. Journal of Arthroplasty, 32(8), 2474–2479.

    Article  Google Scholar 

  9. Monk, T. G., Bronsert, M. R., Henderson, W. G., et al. (2015). Association between intraoperative hypotension and hypertension and 30-day postoperative mortality in noncardiacsurgery. Anesthesiology, 123(2), 307–319.

    Article  Google Scholar 

  10. Frndak, P. A., Mallory, T. H., & Lombardi, A. V. (1993). Translateral surgical approach to the hip. The abductor muscle ‘split.’ Clinical Orthopaedics and Related Research, 295, 135–141.

    Google Scholar 

  11. Perumal, R., Krishnamoorthy, V. P., & Poonnoose, P. M. (2017). Templating digital radiographs using acetate templates in total hip arthroplasty. JAJS, 4, 121–126.

    Google Scholar 

  12. Dolhain, P., Tsigaras, H., Bourne, R. B., Rorabeck, C. H., Mac Donald, S., & McCalden, R. (2002). The effectiveness of dual offset stems in restoring offset during total hip replacement. Acta Orthopaedica Belgica, 68(5), 490–499.

    CAS  PubMed  Google Scholar 

  13. Fillingham, Y. A., Ramkumar, D. B., Jevsevar, D. S., et al. (2019). Tranexamic acid in total joint arthroplasty: The endorsed clinical practice guides of the American Association of Hip and Knee Surgeons, American Society of Regional Anesthesia and Pain Medicine, American Academy of Orthopaedic Surgeons, Hip Society, and Knee Society. Regional Anesthesia & Pain Medicine, 44, 7–11.

    Article  Google Scholar 

  14. Srampickal, G. M., Jacob, K. M., Kandoth, J. J., et al. (2019). How effective is periarticular drug infiltration in providing pain relief and early functional outcome following total hip arthroplasty? Journal of Clinical Orthopaedics & Trauma, 10(3), 550–554.

    Article  Google Scholar 

  15. Goodman, S. M., Springer, B., Guyatt, G., et al. (2017). 2017 American College of Rheumatology/American Association of Hip and Knee Surgeons Guideline for the Perioperative Management of Antirheumatic Medication in Patients With Rheumatic Diseases Undergoing Elective Total Hip or Total Knee Arthroplasty. Journal of Arthroplasty, 32(9), 2628–2638.

    Article  Google Scholar 

  16. Kumar, P., Sen, R., Aggarwal, S., Agarwal, S., & Rajnish, R. K. (2019). Reliability of modified harris hip score as a tool for outcome evaluation of total hip replacements in Indian population. Journal of Clinical Orthopaedics and Trauma, 10(1), 128–130.

    Article  Google Scholar 

  17. Bhan, S., Eachempati, K. K., & Malhotra, R. (2008). Primary cementless total hip arthroplasty for bony ankylosis in patients with ankylosing spondylitis. Journal of Arthroplasty, 23(6), 859–866.

    Article  Google Scholar 

  18. Li, J., Wang, Z., Li, M., Wu, Y., Xu, W., & Wang, Z. (2013). Total hip arthroplasty using a combined anterior and posterior approach via a lateral incision in patients with ankylosed hips. Canadian Journal of Surgery, 56(5), 332–340.

    Article  Google Scholar 

  19. Stefl, M., Lundergan, W., Heckmann, N., et al. (2017). Spinopelvic mobility and acetabular component position for total hip arthroplasty. The Bone & Joint Journal, 99-B, 37–45.

    Article  CAS  Google Scholar 

  20. Ike, H., Dorr, L. D., Trasolini, N., Stefl, M., McKnight, B., & Heckmann, N. (2018). Spine–pelvis–hip relationship in the functioning of a total hip replacement. Journal of Bone and Joint Surgery, 100(18), 1606–1615.

    Article  Google Scholar 

  21. Abdel, M. P. (2019). Simplifying the hip–spine relationship for total hip arthroplasty: When do i use dual-mobility and why does it work? Journal of Arthroplasty, 34(7), S74–S75.

    Article  Google Scholar 

  22. Parvizi, J., Pour, A. E., Peak, E. L., Sharkey, P. F., Hozack, W. J., & Rothman, R. H. (2006). One-stage bilateral total hip arthroplasty compared with unilateral total hip arthroplasty: A prospective study. Journal of Arthroplasty, 21, 26–31.

    Article  Google Scholar 

  23. Bangjian, H., Peijian, T., & Ju, L. (2012). Bilateral synchronous total hip arthroplasty for ankylosed hips. International Orthopaedics, 36(4), 697–701.

    Article  Google Scholar 

  24. Wang, W., Huang, G., Huang, T., & Wu, R. (2014). Bilaterally primary cementless total hip arthroplasty in patients with ankylosing spondylitis. BMC Musculoskeletal Disorders, 11(15), 344.

    Article  Google Scholar 

  25. Ye, C., Liu, R., Sun, C., et al. (2014). Cementless bilateral synchronous total hip arthroplasty in ankylosing spondylitis with hip ankylosis. International Orthopaedics, 38(12), 2473–2476.

    Article  Google Scholar 

  26. Feng, D.-X., Zhang, K., Zhang, Y.-M., et al. (2016). Bilaterally primary cementless total hip arthroplasty for severe hip ankylosis with ankylosing spondylitis. Orthopaedic Surgery, 8(3), 352–359.

    Article  Google Scholar 

  27. Wykman, A., & Olsson, E. (1992). Walking ability after total hip replacement. A comparison of gait analysis in unilateral and bilateral cases. Journal of Bone and Joint Surgery, 74(1), 53–56.

    Article  CAS  Google Scholar 

  28. Lin, D., Charalambous, A., & Hanna, S. A. (2019). Bilateral total hip arthroplasty in ankylosing spondylitis: A systematic review. EFORT Open Reviews, 4(7), 476–481.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedics, Christian Medical College, Vellore, Tamil Nadu, 632004, India

    Rahul George, V. J. Chandy, A. I. Christudoss, T. D. Hariharan, A. ArunShankar, A. T. Oommen & Pradeep Mathew Poonnoose

  2. Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, 632002, India

    B. Antonisamy

Authors
  1. Rahul George
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  2. V. J. Chandy
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  3. A. I. Christudoss
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  4. T. D. Hariharan
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  5. A. ArunShankar
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  7. A. T. Oommen
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  8. Pradeep Mathew Poonnoose
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Contributions

Concepts: AIC, PMP. Design: RG, VJC, AIC, PMP. Definition of intellectual content: RG, VJC, AIC, ATO, PMP. Literature search: RG, VJC, AIC, AAS, PMP. Data collection: RG, VJC, AIC, TDH, AAS. Data analysis: RG, VJC, AIC, AAS, BA, PMP. Manuscript preparation: RG, VJC, AIC, TDH, BA, ATO, PMP, Manuscript editing: RG, VJC, AIC, TDH, AAS, BA, ATO, PMP. Manuscript review: RG, VJC, AIC, TDH, AAS, BA, ATO, PMP. Guarantor: RG, VJC, AIC, PMP.

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Correspondence to Pradeep Mathew Poonnoose.

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George, R., Chandy, V.J., Christudoss, A.I. et al. Peri-operative Morbidity Associated with Bilateral Hip Arthroplasty for Inflammatory Arthritis: Results from a Consecutive Series of 168 Hips. JOIO 55, 1232–1239 (2021). https://doi.org/10.1007/s43465-021-00474-7

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