Single-stage bilateral cemented total hip replacement: is it safe and effective?

Abstract

Concerns regarding single-stage bilateral total hip arthroplasty (THA) remain among orthopaedic surgeons in the UK, primarily with regard to rehabilitation, function, and complications. Between 1998 and 2002, 1,215 patients had a primary THA in our centre. We reviewed prospectively collected data on 264 of these patients who had symptoms from both hips. Of these patients, 49 had a bilateral THA at the same operation and 215 had a unilateral THA. We compared these two groups and found that, pre-operatively, there were no significant differences in sex, body mass index, American Society of Anesthesiologists scores, smoking history, or overall Harris Hip Score (HHS). The patients in the bilateral group were significantly younger. Our results showed no significant differences in complications between the two groups in terms of death, infection, dislocation, or revision at 6 months. Postoperative HHSs at 6 months were almost the same, again with no significant difference. Length of stay was increased for the group having single-stage bilateral THA, but even when corrected for age, was significantly shorter than twice as long at 173%. We did see an increased risk of blood transfusion in the bilateral group, 78% of patients requiring blood, against 22% of patients having a unilateral THA. We know from previous studies that single-stage bilateral THA is cheaper and the benefits to the patient are many. We therefore conclude that single-stage bilateral THA should be taken up more widely in the UK in a selected, generally younger patient group.