Abstract
Many patients suffer from bilateral hip disease. For these patients two-stage bilateral total hip replacement (THR) is more common than a one-stage procedure because of fear of complications associated with one-stage surgery. However, many studies are in favour of one-stage bilateral THR in healthy and young patients. We investigated costs, complications and patient-reported outcome related to one-stage bilateral THR. Unilateral THR was used as a reference. Thirty-two patients with one-stage bilateral THR were prospectively followed for six years (bilateral group). A matched reference population of 32 patients with unilateral THR was assembled (unilateral group). Medical records, individual data from the Swedish Hip Arthroplasty Register, the Swedish Social Insurance Administration and local data on cost per patient were used for the analyses. For non-retired patients, the duration and costs for sick leave during the first postoperative year were similar in both groups. The rate of complications and their severity were similar in both groups. Using cost data from this study in a theoretical model, comparing one- and two-staged procedures showed a 24% reduction in hospital and sick-leave costs in favour of the one-stage procedure. Our results indicate that the one-stage procedure is cost-saving compared to two-stage procedures for patients with indication for bilateral THR.
Highlights
A substantial proportion of patients with hip disease suffer from a bilateral condition [1] and approximately 20% of all total hip replacement (THR) patients undergo surgery on the contralateral hip at some point [2]
Among all patients eligible for THR, the prevalence of a bilateral hip disease that meets the indication for surgery on both hips at a time is not known
As far as we know no previous studies have focused on the indirect costs and health-related quality of life (HRQoL) following onestage bilateral THR
Summary
A substantial proportion of patients with hip disease suffer from a bilateral condition [1] and approximately 20% of all THR patients undergo surgery on the contralateral hip at some point [2]. This study stems from a randomized clinical trial in which 32 patients had one-stage bilateral hybrid THR comparing highly cross-linked polyethylene liner and conventional polyethylene liner. These patients were their own controls [15]. From the same hospital and period we assembled a reference group of 32 patients with unilateral THR to match the one-stage bilateral patients with regard to age, sex, diagnosis, co-morbidity, type of implant and postoperative regime. This model assumed that each unilateral THR represented the first operation of a two-stage procedure. We calculated both direct medical and indirect non-medical costs for the two procedures
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