A NSQIP Analysis of Complications after Simultaneous Bilateral Total Hip Arthroplasty

Abstract

AbstractSimultaneous bilateral total hip arthroplasty (blTHA) offers the benefit of a single episode of care with the potential for lower cumulative operative times and rehabilitation periods than staged bilateral total hip arthroplasty (stTHA). This study analyzes short-term complication rates after blTHA relative to unilateral THA (ulTHA) and projected stTHA in patients with bilateral hip osteoarthritis. We compared complications in a simultaneous blTHA group and a ulTHA group using the National Surgical Quality Improvement Program (NSQIP) database. ulTHA patients were propensity-matched two-to-one against blTHA patients using morbidity probability score. Thirty-day complication rates were compared. Outcomes in staged procedures (stTHA) were projected by doubling complication rates in ulTHA procedures. There were 805 blTHA patients and 1,610 ulTHA patients used to estimate stTHA outcomes. The rate of major complications or death after blTHA was no higher than the projected stTHA rate (2.0 vs 3.0%, p = 0.179), but minor complications were more common after blTHA than stTHA projections (13.5 vs 6.8%, p < 0.001). Mean operative time for blTHA was 39.2 minutes shorter than that for stTHA (p < 0.001); mean hospital stay was 1 day shorter for blTHA than that for stTHA (p < 0.001). Thirty-day rates of periprosthetic fracture (0.62 vs 0.12%, p = 0.045) and dislocation (0.50 vs 0.1%, p = 0.1) were higher after blTHA than stTHA. Simultaneous blTHA appears safe in patients medically fit to tolerate longer uninterrupted surgery and appears to shorten operative time and hospital stay relative to staged THA. There is a significantly higher risk of blood transfusion, periprosthetic fracture, and dislocation after blTHA.