Abstract
Background
Rationale for symptomatic severe bilateral arthritis of the hip is sequential bilateral THR completed under the same anaesthesia. The rarity of procedures and apprehension of complications preclude the widespread use.
Materials and Methods
Retrospective analysis of prospectively collected data from 108 patients (216 hips) with bilateral arthritis who underwent total hip arthroplasties was done: out of which 54 patients (108 hips) underwent a single-stage sequential procedure (sequential group) and a matched group of 54 patients (108 hips) underwent a two-stage procedure at different admissions (staged group). Patients were matched according to age (± 2 years), gender, American Society of Anaesthesiologists classification, perioperative management protocol and diagnosis. The mean duration of follow-up for sequential group was 5.1 years while that of staged group was 5.3 years.
Results
Most patients (88.88%) were operated with uncemented implants having ceramic on ceramic bearing surfaces under spinal or general anaesthesia. The operating time, post-op limb length and functional outcomes of both groups were comparable. Although the total estimated blood loss was significantly less in the sequential group (502 ml) as compared to the staged group (570 ml), the mean blood transfusion requirement was significantly higher (1.6 units) in the sequential group as compared to that in the staged group (0.9 units). The mean cumulative length of hospital stay was significantly longer in the staged group (23 days) compared with the sequential group (16 days).
Conclusion
Single-stage bilateral total hip arthroplasty is a safe and viable option when performed with expertise in appropriately selected patients without any surge in complications.
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References
Cammisa, F. P., Jr., O’Brien, S. J., Salvati, E. A., Sculco, T. P., Wilson, P. D., Jr., Ranawat, C. S., Pellicci, P. M., & Inglis, A. E. (1988). One-stage bilateral total hip arthroplasty. A prospective study of perioperative morbidity. Orthopedic Clinics of North America, 19, 657–658.
Lazansky, M. G. (1967). A method for grading hips. The Journal of Bone and Joint Surgery. British Volume, 49-B, 644–651.
Macaulay, W., Salvati, E. A., Sculco, T. P., & Pellicci, P. M. (2002). Single-stage bilateral total hip arthroplasty. Journal of American Academy of Orthopaedic Surgeons, 10, 217–221.
Salvati, E. A., Hughes, P., & Lachiewicz, P. (1978). Bilateral total hip-replacement arthroplasty in one stage. The Journal of Bone and Joint Surgery. American Volume, 60-A, 640–644.
Ritter, M. A., & Randolph, J. C. (1976). Bilateral total hip arthroplasty: a simultaneous procedure. Acta Orthopaedica Scandinavica, 47, 203–208.
Wykman, A., & Olsson, E. (1992). Walking ability after total hip replacement: a comparison of gait analysis in unilateral and bilateral cases. The Journal of Bone and Joint Surgery. British Volume, 74, 53–56.
Shih, C. H., & Ho, W. B. (1985). One-stage versus two-stage bilateral autophor ceramic total hip arthroplasty. Clinical Orthopaedics, 193, 141–145.
Eggli, S., Huckell, C. B., & Ganz, R. (1996). Bilateral total hip arthroplasty: one stage versus two stage procedure. Clinical Orthopaedics and Related Research, 328, 108–118.
Bracy, D., & Wroblewski, B. M. (1981). Bilateral Charnley arthroplasty as a single procedure. A report on 400 patients. The Journal of Bone and Joint Surgery. British Volume, 63, 354–356.
Whitley, E., & Ball, J. (2002). Statistics review 4: sample size calculations. Critical Care, 6(4), 1–7.
British Orthopaedic Association. (2005). Blood conservation in elective orthopaedic surgery. BOA.
Berger, R. A., Curran, A., Uyen, V., Jacobs, J. J., Rosenberg, A. G., Sheinkop, M. B., & Galante, J. O. (2000). Complications of simultaneous versus staged bilateral total hip arthroplasty. In Proc 67th Ann Meet AAOS, p. 504.
Berend, M. E., Ritter, M. A., Harty, L. D., Davis, K. E., Keating, E. M., Meding, J. B., & Thong, A. E. (2005). Simultaneous bilateral versus unilateral total hip arthroplasty an outcomes analysis. The Journal of Arthroplasty, 20, 421–426.
Agins, H. J., Salvati, E. A., Ranawat, C. S., Wilson, P. D., Jr., & Pellicci, P. M. (1988). The nine- to fifteen-year follow-up of one-stage bilateral total hip arthroplasty. Orthopedic Clinics of North America, 19, 517–530.
Ritter, M. A., & Stringer, E. A. (1980). Bilateral total hip arthroplasty: a single procedure. Clinical Orthopaedics and Related Research, 149, 185–190.
Salvati, E. A., Hughes, P., & Lachiewicz, P. (1978). Bilateral total hip-replacement in one stage. The Journal of Bone and Joint Surgery. American Volume, 60, 640–644.
Soong, M., Rubash, H. E., & Macaulay, W. (2004). Dislocation after total hip arthroplasty. Journal of American Academy of Orthopaedic Surgeons, 12, 314–321.
Alfaro-Adrian, J., Bayona, F., Rech, J. A., & Murray, D. W. (1999). One- or two-stage bilateral total hip replacement. Journal of Arthroplasty, 14, 439–445.
Bhan, S., Pankaj, A., & Malhotra, R. (2006). One- or two-stage bilateral total hip arthroplasty. The Journal of Bone and Joint Surgery. British Volume, 88-B, 298–303.
Parvizi, J., Tarity, D. T., Shaikh, E. S., Sharkey, P. F., et al. (2006). Bilateral total hip arthroplasty one-stage versus two-stage procedures. Clinical Orthopaedics and Related Research, 453, 137–141. https://doi.org/10.1097/01.blo.0000246529.14135.2b
Wykman, A., & Olsson, E. (1992). Walking ability after total hip replacement: a comparison of gait analysis in unilateral and bilateral cases. The Journal of Bone and Joint Surgery. British Volume, 74-B, 53–56.
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Panchal, S., Jogani, A.D., Mohanty, S.S. et al. Is Bilateral Sequential Total Hip Replacement as Safe an Option as Staged Replacement? A Matched Pair Analysis of 108 Cases at a Tertiary Care Centre. JOIO 55, 1250–1255 (2021). https://doi.org/10.1007/s43465-021-00536-w
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DOI: https://doi.org/10.1007/s43465-021-00536-w