Contralateral Total Hip Arthroplasty Staged Within Six Weeks Increases the Risk of Adverse Events Compared to Unilateral Surgery

Abstract

BackgroundThe ideal timing for bilateral total hip arthroplasty (THA) remains controversial. This study compared 90-day outcomes after simultaneous bilateral THA and contralateral surgery in staged bilateral THA to a matched cohort of unilateral procedures. MethodsPatients undergoing primary, elective THA during 2015 to 2020 were reviewed in a national database. Of the 273,281 patients identified, 39,905 (14.6%) were bilateral. Patients were divided into cohorts of unilateral THA, simultaneous bilateral THA, and staged bilateral THA at 1 to 14 days, 15 to 42 days, 43 to 90 days, and 91 to 365 days. Bilateral THA cohorts were matched with unilateral THA patients based on demographics and comorbidities. Ninety-day outcomes after the second THA were compared between matched groups. ResultsSimultaneous bilateral THA resulted in higher rates of transfusion (odds ratio [OR] 4.43, 95% confidence interval 2.31-2.63, P < .001), readmission (OR 2.60, 2.01-3.39, P < .001), and any complication (OR 1.86, 1.55-2.24, P < .001) compared to unilateral THA. Contralateral THA staged at 1 to 14 days increased the risk of readmission (OR 1.83, 1.49-2.24, P < .001) and any complication (OR 1.45, 1.26-1.66, P < .001) relative to unilateral THA. Contralateral THA staged at 15 to 42 days increased the risk of periprosthetic joint infection (OR 3.15, 1.98-5.19, P < .001), readmission (OR 1.92, 1.55-2.39, P < .001), and any complication (OR 1.70, 1.46-1.97, P < .001). Contralateral THA staged beyond 42 days resulted in similar or decreased rates of adverse events relative to unilateral THA. ConclusionsBilateral THA should be staged a minimum of 6 weeks apart in appropriately selected patients to avoid an increased risk of adverse events after the second THA compared to unilateral THA.