Bilateral Total Hip Arthroplasty Research Articles

Minimum 30-Year Results of Bilaterally Implanted Cemented and Cementless Total Hip Arthroplasty in Patients Younger Than 50 Years

BackgroundThe rate of failure of cemented and cementless total hip arthroplasty (THA) in younger patients is higher than that in elderly patients. The purpose of this study is to document the long-term clinical results of THA with the so-called third-generation cementing and the results of second-generation cementless THA in patients <50 years of age. MethodsThis study included 106 patients who had had bilateral THA with a cemented stem in one hip and a cementless stem in the other. There were 78 men and 28 women. Their mean age was 47 years (range, 21-49). The average follow-up duration was 31 years (range, 30-32.5). ResultsThere were similar mean Harris Hip Scores (90 versus 91 points) between the groups at the final follow-up. Forty-six acetabular components (43%) in the cemented group and 48 acetabular components (45%) in the cementless group were revised. Five femoral components (5%) in the cemented group and 4 femoral components (4%) in the cementless group were revised. Survivorship of the acetabular component at 30.8 years was similar in both groups (57% in the cemented group versus 55% in the cementless group). Survivorship of the femoral component at 30.8 years was also similar in both groups (95% in the cemented group versus 96% in the cementless group). ConclusionLong-term fixation of the cemented or cementless femoral stem was outstanding. There was a high rate of the acetabular component revision due to conventional polyethylene wear and periacetabular osteolysis in both hybrid and fully cementless THA groups.

Comparison between simultaneous bilateral total hip arthroplasty with and without drainage: A retrospective cohort study.

Simultaneous bilateral total hip arthroplasty (SBTHA) is an effective procedure for patients with disease bilaterally. But there is concern about increased blood loss and complications of SBTHA than staged total hip arthroplasty (THA). This study aimed to evaluate the differences in the clinical outcomes and complication rate of SBTHA with drainage and without drainage for reducing the concerns. Between October 2015 and April 2019, a retrospective cohort study was conducted with modified minimally invasive 2-incision method and a consecutive series of 41 SBTHA performed with drainage (Group I) were compared to 37 SBTHA performed without drainage (Group II). It was assessed clinically and radiographically for a mean of 2.1 ± 0.8 years (range, 1.0-4.8 years). Postoperative hematologic values (Hgb loss, total blood loss, transfusion rate), pain susceptibility, functional outcome (Harris Hip Score, Western Ontario and McMaster Universities Osteoarthritis Index score) and complication were compared in the drained group and the non-drained group. Postoperative Hgb loss (I: 2163.2 ± 698.7 g, II: 1730.4 ± 572.5 g; P = .002), total blood loss (I: 1528.8 ± 421.7 mL, II: 1237.6 ± 325.9 mL; P = .001) and mean transfusion unit (I: 0.7 ± 1.0 IU, II: 0.1 ± 0.3 IU; P < .001) were significantly lower in the without drainage group than in the with drainage group. But the morphine equivalent (I: 132.7 ± 314.1 mg, II: 732.2 ± 591.5 mg; P < .001) was significantly larger in the without drainage group. No significant difference was found between the drainage group and without drainage group in Harris Hip Score and Western Ontario and McMaster Universities Osteoarthritis Index score at final follow-up. SBTHA without drainage can reduce postoperative blood loss and the requirement for transfusion without increasing other complication. But SBTHA without drainage is more painful method than SBTHA with drainage. Therefore, SBTHA without drainage will be a good option to reduce the burden on the patient by reducing postoperative bleeding if it can control pain well after surgery. III, Retrospective case-control study.

Two Teams Simultaneous Bilateral Total Hip Arthroplasty via Direct Anterior Approach in an Ordinary Table -A Comparative Study with Matched Pair of Consecutive Bilateral Total Hip Arthroplasty

Introduction: The Direct Anterior Approach (DAA) has regained its popularity in total hip arthroplasty (THA). We conducted a pilot study to compare the outcome of two team simultaneous bilateral THA by DDA with a control cohort of patients who underwent single stage bilateral THA by DAA in consecutive fashion. Methods: Group A consisting of patients who underwent two team simultaneous bilateral THA by DAA in ordinary table were matched with a cohort of patients in Group B who underwent consecutive (one after the other) bilateral THA in same sitting by DAA. The parameters compared were Surgical time, Blood loss, Blood Transfusion, Opioid requirement, Length of hospital stay, complication, and the cost. Results: The mean operating time was 99 ± 20.9 minutes in group A as compared with 211.5 ± 27 minutes in group B. This difference was highly significant. The mean intraoperative blood loss in group B (1260 ± 397 ml) was greater than that in group A (930 ± 344 ml). However, this difference was not statistically significant. There was no significant difference between two groups in terms of fall in hemoglobin, blood transfused and opioid requirement. Two team simultaneous THA reduced the duration of operation by an average of 112.5 minutes which equates to approximately Rs.77,287.5 (US$ 1033.77) saved per patient as per our institutional report. Conclusion: Our study suggests that 2 team simultaneous bilateral THA by DAA is equally safe rather less costlier than the consecutive procedure in patients with bilateral hip disease and adequate medical condition.

Is simultaneous bilateral total hip arthroplasty deleterious in a biomechanical point of view? A comparative gait analysis study

PurposeUni- or bilateral hip osteoarthritis is a common disease generating pain, stiffness, and functional disabilities. Changes in the normal walking with higher energy expenditures are observed. Facing a cruel lack of biomechanical data, we decided to analyse the impact on the walking of single and simultaneous bilateral total hip arthroplasties (THA).MethodWe conducted a prospective monocentric study, comparing two matched groups of 15 patients able to walk with symptomatic isolated uni- (group 1) or bilateral HO (group 2) and treated respectively by unilateral THA (UTHA) or simultaneous bilateral THA (SBTHA). Surgery was performed by a single surgeon with a direct anterior approach and approved by local ethical committee. Walking was assessed by a « 3D Gait analysis motion» pre and at 6 months post operatively.ResultIn the UTHA group, recovery, i.e., efficiency of locomotor mechanism (p < 0.001) and pelvis sagittal balance (p = 0.031) improved, while external and total work (p = 0.010) decreased post operatively. In the SBTHA group, speed (p = 0.035), step length (p = 0.046), range of motion of knee sagittal stance (p = 0.009) and hip frontal (p = 0.031), and internal work are significatively higher (p < 0.001) post operatively.ConclusionsThis original study attests that THA has a positive impact on walking and energetics outcome in UTHA and SBTHA.

Bilateral Avascular Necrosis of the Femoral Heads

A 34-year-old woman was referred to physical therapy for severe, progressive bilateral hip pain. Due to minimal improvement after six physical therapy sessions and a history of chronic alcoholism, the patient was referred back to her physician for imaging. Her imaging showed severe bilateral avascular necrosis of the femoral heads, necessitating bilateral total hip arthroplasties. JOSPT Cases 2022;2(3):149–151. doi:10.2519/josptcases.2022.10966

Bilateral synchronous total hip arthroplasty for end-stage arthropathy in hemophilia A patients: A retrospective study.

Total hip arthroplasty (THA) has been an effective tool of advanced hemophiliac hip arthritis. There are only limited data of bilateral synchronous THA for end-stage arthropathy in hemophilia A patients.The aim of this retrospective study was to analyze clinical outcome and complication rate of bilateral THA for hemophilia A patients with end-stage arthropathy of hip and review the operative strategy.From August 2012 to July 2016, 48 hips of 24 patients with hemophilia A patients underwent THA by a single experienced chief orthopedic surgeon. Clinical and radiological evaluations were included of operation time, blood loss, the quantity of blood transfusion, clotting factor consumption, duration of hospitalization, modified Harris hip score, complication rate, and radiographic assessment.All the 24 patients successfully completed the operation, followed up for 5 to 8 years, and the mean time was 6.5 years. The average operation time was 140 minutes (range, 120–180 minutes). The average total blood loss was 225 mL (range, 150–400 mL). The mean red blood cell transfusion amount was 2.4 U (range, 0–6 U). the mean hospitalization time was 24 days (range, 16–46 days). The mean amount of clotting factor VIII used in the perioperative period for management of hemophilia A was 30,600 U (range, 18,000–52,000 U). Average modified Harris hip score increased from 46.6 (range 28–70) points preoperatively to 90.2 (range 75–98) points at final follow-up, complications were few.With excellent operative techniques and hematological management, bilateral synchronous THA for end-stage arthropathy in hemophilia A patients can provide satisfactory outcomes.

Treatment patterns and clinical and economic burden of hip dislocation following primary total hip arthroplasty in England.

AimsThe aim of this study was to estimate the clinical and economic burden of dislocation following primary total hip arthroplasty (THA) in England.MethodsThis retrospective evaluation used data from the UK Clinical Practice Research Datalink database. Patients were eligible if they underwent a primary THA (index date) and had medical records available 90 days pre-index and 180 days post-index. Bilateral THAs were excluded. Healthcare costs and resource use were evaluated over two years. Changes (pre- vs post-THA) in generic quality of life (QoL) and joint-specific disability were evaluated. Propensity score matching controlled for baseline differences between patients with and without THA dislocation.ResultsAmong 13,044 patients (mean age 69.2 years (SD 11.4), 60.9% female), 191 (1.5%) had THA dislocation. Two-year median direct medical costs were £15,333 (interquartile range (IQR) 14,437 to 16,156) higher for patients with THA dislocation. Patients underwent revision surgery after a mean of 1.5 dislocations (1 to 5). Two-year costs increased to £54,088 (IQR 34,126 to 59,117) for patients with multiple closed reductions and a revision procedure. On average, patients with dislocation had greater healthcare resource use and less improvement in EuroQol five-dimension index (mean 0.24 (SD 0.35) vs 0.44 (SD 0.35); p < 0.001) and visual analogue scale (0.95 vs 8.85; p = 0.038) scores, and Oxford Hip Scores (12.93 vs 21.19; p < 0.001).ConclusionThe cost, resource use, and QoL burden of THA dislocation in England are substantial. Further research is required to understand optimal timing of revision after dislocation, with regard to cost-effectiveness and impact on QoL.Cite this article: Bone Joint J 2022;104-B(7):811–819.

Comparative study of bilateral total hip arthroplasty in one or two stages

IntroductionBilateral total hip arthroplasty (Bi THA) for disabling bilateral hip osteoarthritis can be performed in one or two operative sessions. The objective of this study was to compare the complication rates of a group of patients who had bilateral THA in one operating session (Bi-1S THA) to a matched group of patients who had bilateral THA in two separate operating sessions (Bi-2S THA). Materials and methodsThis retrospective case-control study compared 84 Bi-1S THA matched to 84 Bi-2S THA by age, gender, diagnosis, ASA score (1–2) and surgical approach. The minimum follow-up was 12 months. Complication rates, total blood loss, number of blood transfusion units, and functional outcomes were assessed. ResultsTwelve patients (14.3%) in the Bi-1S THA group had minor or major complications, compared to twenty-one (25%) in the Bi-2S THA group (p=0.08): there were fewer minor complications in the Bi-1S THA group and a similar rate of major complications amongst the two groups. Total blood loss estimated using the OSTHEO formula was significantly lower in patients operated on by Bi-1S THA (1853±753mL versus 2804±1012mL, p <0.0001). The number of blood transfusion units was similar between the groups (0.5±0.8 versus 0.3±1.4 respectively, p=0.55). No significant difference was found regarding the functional results. ConclusionUnder the conditions of this study, bilateral total hip arthroplasty in one operative session leads to fewer minor complications, and a similar rate of major complications, when compared to bilateral total hip arthroplasty in two separate sessions. This strategy can therefore be recommended for ASA 1 and 2 patients, under the age of 80 with disabling bilateral osteoarthritis. Level of evidenceIII, retrospective comparative study.

Impact of computed tomography metal artifact reduction protocol on periprosthetic tissue characterization after total hip arthroplasty:A cadaveric study.

Metal artifact reduction (MAR) has improved computed tomography (CT) imaging of total hip arthroplasty (THA) but the assessment of osteolysis and implant to bone contact relies on the accurate depiction of bone defects, cancellous bone, and cement. This study evaluates the impact of available single and dual-energy protocols on periprosthetic tissue characterization in a cadaveric phantom. Bilateral THA was performed on a fresh frozen cadaveric pelvis with simulated osteolytic cavities. CT acquisitions with projection-basedMAR and noise equivalence were performed using single energy 140 kVp, single energy 150 kVp with 0.6 mm tin filtration, and dual-energy at 100/150 kVp with 0.6 mm tin filtration, from which simulated energies were extracted. Image subtraction, segmentation, region of interest histograms, and line profiles were used to characterize tissue density and separation. Tissue densities were heavily dependent on the energy profile of the protocol. Cancellous bone ranged from 182to 45 HU and cement from 1012to 131 HU using 140 kVp compared to dual-energy with weighted high energy tube, respectively. Spectral separation between cancellous bone, osteolytic defect, and cement was reduced for all protocols compared with 140 kVp. Spectral overlap was most severe using dual-energy with heavily weighted high-energy tubes. Dual-energy algorithms reduced trabecular contrast within the cancellous bone and cortical edge response. Althoughthe dual-energy acquisition has been proposed as an additive to projection-based MAR techniques in THA, reduced density and contrast in clinically relevant periprosthetic tissue compared to 140 kVp single energy may limit its use in characterizing periprosthetic tissues.

One-stage bilateral hip arthroplasty

Introduction: The unilateral total hip arthroplasty is a routine surgical intervention, but in the mean time in several institutions over the world, they perform also bilateral total hip arthroplasty as a one-stage surgery, with different indications. Objective: The aim of this study is to present through our cases and through the international literature the indication criteria, the absolute and relative contraindications, and the potential difficulties of one-stage bilateral hip arthroplasty, showing also the real state of this intervention in our healthcare and financial situation. Method: In this publication, we review - in relation to our five cases - the possibilities of bilateral total hip arthroplasty, their indications and differences compared to the unilateral intervention, and also its financial background. Results: We had neither surgical nor internal medicine complications. Comparing to unilateral hip arthroplasty, patients needed no higher quantity of blood transfusion, but the hospitalization period was 1,5-2 times longer in our cases. Difficulties of mobilization were according more to their internal medical status. Conclusion: According to our experience, the one-stage bilateral hip arthroplasty, with well considered indication range, can be performed safely in adequate internal medicine state of the patient, involving the cardiology and reumatology specialist, with careful anesthesia preparation. The financial side of this intervention is not yet solved at the National Health Insurance Fund of Hungary.

Dexamethasone Attenuates the Perioperative Acute Phase Response for Simultaneous Bilateral Total Hip Arthroplasty.

This study aimed to evaluate the effect of perioperative dexamethasone on acute phase response (APR) after simultaneous bilateral total hip arthroplasty (SimBTHA). A retrospective case-control study was performed on 177 SimBTHA procedures. The patients were divided into 2 cohorts: patients receiving perioperative dexamethasone and patients in whom no dexamethasone was administered. We observed the effects of perioperative dexamethasone on the APR following SimBTHA by trending C-reactive protein and interleukin-6. Besides, the incidence of postoperative nausea and vomiting (PONV), postoperative visual analog scale (VAS) score, use of antiemetic and analgesic rescue, and complications were also compared. Compared to the no dexamethasone group, patients receiving dexamethasone yielded a significantly decreased C-reactive protein on postoperative days 1, 2 and 3. Such differences of interleukin-6 were also detected. In addition, the incidence of PONV, postoperative VAS score, and use of antiemetic and analgesic rescue were significantly decreased without increasing the risk of early surgical wound infection and gastrointestinal hemorrhage in patients receiving dexamethasone. The anti-inflammatory effects of dexamethasone can attenuate the APR after SimBTHA as well as decrease the PONV, postoperative VAS score, and use of antiemetic and analgesic rescue.

Adult presentation of severe sequelae of Tom Smith arthritis treated with bilateral total hip arthroplasty: A case report.

Introduction and importanceTom Smith arthritis (TSA) is a pyogenic arthritis of the hip joint that occurs in infancy and has considerable morbidity. Reports on surgical management of severe hip dysplasia in adulthood secondary to TSA are extremely limited. We describe a patient who successfully underwent a bilateral total hip arthroplasty for the severely damaged hip joints secondary to TSA with satisfactory functional outcomes.Case presentationA 25-year-old female was unable to walk for more than 10 ft due to pain in both hips and knees predominantly on the left side. She developed pyogenic septic arthritis with sepsis at 6 weeks of age and underwent multiple surgical procedures to drain the infection and for reconstruction. She had limited range of motion and was severely disabled. She underwent an uneventful left total hip arthroplasty and two years later, a right total hip arthroplasty using S-ROM modular hip systems. The pre and post-operative Harris Hips scores were 53.4 (left), 46 (right) and 95.7 (left), 89.65 (right), respectively.Clinical discussionDetailed preoperative evaluation of the anatomy was paramount. Assessment of the limb-length discrepancy by means of scanogram, templating the anatomy with computed tomography and planning the anatomical location of the centre of the relocated hip were mandatory.ConclusionBilateral total hip arthroplasty is a feasible option to manage the rare occurrence of severely damaged bilateral hip joints caused by TSA presenting in adulthood. Reconstructive options for late sequelae should be individualized based on the degree of involvement, hip stability, and patient expectations.

Fourth-Generation Ceramic-on-Ceramic THA in Patients with Ankylosing Spondylitis: A Minimum 10-Year Follow-Up.

ObjectiveTo report the long‐term outcomes of total hip arthroplasty (THA) with fourth‐generation ceramic‐on‐ceramic (CoC) bearing in patients with ankylosing spondylitis (AS).MethodsWe retrospectively identified 180 primary THAs performed in 110 patients with AS, including 100 (90.9%) men and 10 women (9.1%), from 2009 to 2011.The mean age of the patients at surgery was 33 years (range, 16 to 65 years). Cementless prostheses with fourth‐generation CoC bearings were used in all patients. Survivorship of the implants and postoperative complications were calculated. Functional improvement was assessed by the hip flexion‐extension range of motion (ROM) and Harris hip score (HHS). A special noise assessment questionnaire was performed at the last follow‐up. The cumulative incidence of noise was calculated by the Kaplan–Meier method with 95% confidence intervals (CIs). Clinical characteristics and functional outcomes were compared in the hips with noise to those without noise.ResultsThe mean follow‐up was 11 years (range, 10 to 12 years), and survivorship of the implants was 99.4% at the most recent follow‐up. The complications included dislocation (one hip, 0.6%), periprosthetic joint infection (one hip, 0.6%), mild to moderate pain (five hips, 2.8%), heterotopic ossification (12 hips, 6.7%), and noise (52 hips, 28.9%). The flexion‐extension ROM improved significantly with a median from 10° (range, 0 ~ 130°) to 100° (30 ~ 130°) after THA (p < 0.001), and the HHS increased significantly from 41 ± 20 to 90 ± 8 (p < 0.001). The cumulative incidence of noise at 0.5, 5, and 10 years was 6.1% (95% CI, 2.6 ~ 9.6), 16.7% (95% CI, 11.2 ~ 22.1), and 28.9% (95% CI, 22.2 ~ 35.5), respectively, and that of squeaking at 0.5, 5, and 10 years was 4.4% (95% CI, 1.4 ~ 7.4), 13.3% (95% CI, 8.4 ~ 18.3), and 23.9% (95% CI, 17.6 ~ 30.1), respectively. None of the patients with noise generation in the hip reported it affecting daily activities or causing dissatisfaction. No differences in age, sex, BMI, disease duration, bilateral THA, the frequency of bony ankylosis, the proportion of using a 36‐mm‐diameter femoral head, pre/postoperative flexion‐extension ROM, or pre/postoperative HHS were found between hips with noise and those without noise (p > 0.05).ConclusionTHAs with fourth‐generation CoC bearings exhibit excellent long‐term survival and clinical outcomes in patients with AS, with a very low dislocation rate. The incidence of noise associated with CoC bearings in THA performed in patients increases over time, but it does not affect postoperative hip function or daily activities.

A rare coexistence of ankylosing spondylitis and SCD: Pitfalls and challenges during THA

The co-existence of Ankylosing Spondylitis (AS) and Sickle Cell Disease (SCD) is extremely rare, and the case of such a patient undergoing Total Hip Arthroplasty (THA) has never been reported. We present a case report of a 39-year-old male with co-existing AS and SCD who underwent staged bilateral THA with good clinical and radiographic outcomes at 5 years follow-up. Co-existing AS and SCD can present unique intraoperative surgical challenges in patients undergoing THA as seen in our patient, and the establishment of perioperative management guidelines may help prevent complications. Keywords: ankylosing spondylitis; sickle cell disease (SCD); total hip arthroplasty (THA); hip.

Consistency of Acetabular Height in Sequential Bilateral Total Hip Arthroplasty.

BackgroundAchieving appropriate leg length after surgery remains a concern for surgeons performing total hip arthroplasty (THA). The focus of surgeons trying to equalize leg length has been primarily on positioning of the femoral implant. This study evaluates the impact of acetabular height on leg length and its impact on femoral component choices during THA.MethodsWe reviewed standing pelvic radiographs of 100 patients who underwent staged bilateral THA by a single surgeon from 2016 to 2019. Leg length discrepancies and acetabular heights were determined from preoperative and postoperative radiographs. The difference between the first and second operative hips was compared at each stage of the procedures. Results were analyzed using paired t-tests.ResultsThere is a significant increase in mean leg length and acetabular height after both the first and second stages of the procedure. Although there was a small change in average acetabular height for each procedure, height increased or decreased by greater than 5 mm in 44 of 200 cases. Comparing left to right hips after the second surgery disclosed no statistically significant differences in acetabular height or leg length.ConclusionAcetabular height and leg length changes with each stage of the procedure in sequential bilateral THA. In almost 25% of cases, the acetabular height changed by more than 5 mm. This has significant implications and needs to be considered during preoperative planning as well as operative decision-making. To account for these differences, a THA may require intraoperative acetabular assessment and changes in femoral positioning and sizing to achieve the optimal leg length.

The risk of all-cause mortality, heart outcomes, cancer, and neurodegenerative disorders with cobalt-chrome-containing total hip arthroplasty implants : an analysis of the National Joint Registry.

A recent report from France suggested an association between the use of cobalt-chrome (CoCr) femoral heads in total hip arthroplasties (THAs) and an increased risk of dilated cardiomyopathy and heart failure. CoCr is a commonly used material in orthopaedic implants. If the reported association is causal, the consequences would be significant given the millions of joint arthroplasties and other orthopaedic procedures in which CoCr is used annually. We examined whether CoCr-containing THAs were associated with an increased risk of all-cause mortality, heart outcomes, cancer, and neurodegenerative disorders in a large national database. Data from the National Joint Registry was linked to NHS English hospital inpatient episodes for 374,359 primary THAs with up to 14.5 years' follow-up. We excluded any patients with bilateral THAs, knee arthroplasties, indications other than osteoarthritis, aged under 55 years, and diagnosis of one or more outcome of interest before THA. Implants were grouped as either containing CoCr or not containing CoCr. The association between implant construct and the risk of all-cause mortality and incident heart failure, cancer, and neurodegenerative disorders was examined. There were 158,677 individuals (42.4%) with an implant containing CoCr. There were 47,963 deaths, 27,332 heart outcomes, 35,720 cancers, and 22,025 neurodegenerative disorders. There was no evidence of an association between patients with CoCr implants and higher rates of any of the outcomes. CoCr-containing THAs did not have an increased risk of all-cause mortality, or clinically meaningful heart outcomes, cancer, or neurodegenerative disorders into the second decade post-implantation. Our findings will help reassure clinicians and the increasing number of patients receiving primary THA worldwide that the use of CoCr-containing implants is not associated with significant adverse systemic effects. Cite this article: Bone Joint J2022;104-B(3):359-367.

What Factors Affect Whether Patients Return to the Same Surgeon to Replace the Contralateral Joint? A Study of Over 200,000 Patients.

Patients with hip and knee arthritis often undergo bilateral total hip arthroplasty (THA) and total knee arthroplasty (TKA) in a staged or simultaneous fashion. However, when staged, the incidence and factors associated with having both procedures performed by the same surgeon or different surgeon are not well studied. All patients undergoing nonsimultaneous bilateral THA or TKA for osteoarthritis were abstracted from the 2010 to 2020 PearlDiver Mariner administrative database. The National Provider Identifier number was used to determine whether the same surgeon performed both surgeries. Demographics, comorbidities, and 90-day complications after the first joint replacement were assessed as possible independent predictors of utilizing a different surgeon for the contralateral joint. Of 87,593 staged bilateral THAs, the same surgeon performed 40,707 (46.5%) arthroplasties. Of 147,938 staged bilateral TKAs, the same surgeon performed 77,072 (52.1%) arthroplasties. Notably, older cohorts of patients had independent, stepwise, and significantly greater odds of changing surgeons for the contralateral THA and TKA. Those patients who were insured by Medicare and Medicaid had significantly lower odds of changing surgeons. For both THA and TKA, surgical and implant-related adverse events (surgical site infection/periprosthetic joint infection, periprosthetic fracture, dislocation, manipulation) carried the greatest odds of undergoing the contralateral replacement with a different surgeon. Patients covered by Medicaid and sicker patients were significancy less likely to switch surgeons for their contralateral THA or TKA. Additionally, patients experiencing a surgery-related adverse event within 90 days of their first THA or TKA had significantly, increased odds of switching surgeons for their subsequent TJA.

Simultaneous Bilateral Total Hip Arthroplasty With Contemporary Blood Management is Associated With a Low Risk of Allogeneic Blood Transfusion.

There is a paucity of data on blood loss and the risk of allogeneic blood transfusion after simultaneous bilateral total hip arthroplasty (SBTHA) with contemporary blood management including neuraxial anesthesia, routine tranexamic acid use, and a restrictive transfusion protocol. As such, we sought to determine the in-hospital outcomes of SBTHA, specifically analyzing blood loss and the rate and risk factors for transfusion. We identified 191 patients who underwent SBTHA at a single institution from 2016 to 2019. No drains were utilized and no patients donated blood preoperatively. Mean age was 59 years with 96 females (50.3%). The surgical approach was posterior in 138 (72.3%) and direct anterior in 53 (27.7%) patients. We analyzed blood loss, the rate of allogeneic blood transfusions, and in-hospital thromboembolic complications. We analyzed risk factors for transfusion with a logistic regression analysis. Twenty-two patients (11.5%) underwent allogeneic blood transfusion. All transfused patients were female. Univariate analysis revealed female gender as a transfusion risk factor since it had statistically significant higher proportion in the transfusion group than the nontransfusion group (100% vs 43.5%, respectively, P < .001). We did not identify any other singular significant risk factors for transfusion in a multivariable regression analysis. However, females with a preoperative Hb <12 had an elevated risk of transfusion at 37.5% (15/40 patients). With contemporary perioperative blood management protocols, there is a relatively low (11.5%) risk of a blood transfusion after SBTHA. Females with a lower preoperative Hb (<12 g/dL) had the highest risk of transfusion at 37.5%.

Hypotensive Anesthesia Combined with Tranexamic Acid Reduces Perioperative Blood Loss in Simultaneous Bilateral Total Hip Arthroplasty: A Retrospective Cohort Study.

ObjectiveTo assess the efficacy and safety of hypotensive anesthesia (HA) combined with tranexamic acid (TXA) for reducing perioperative blood loss in simultaneous bilateral total hip arthroplasty (SBTHA).MethodsIn this retrospective cohort study, a total of 183 eligible patients (15 females and 168 males, 44.01 ± 9.29 years old) who underwent SBTHA from January 2015 to September 2020 at our medical center were enrolled for analysis. Fifty‐nine patients received standard general anesthesia (Std‐GA group), the other 85 and 39 patients received HA with an intraoperative mean arterial pressure between 70 and 80 mmHg (70–80 HA group) and below 70 mmHg (<70 HA group), respectively. TXA was administrated to all patients. Perioperative blood loss (total, dominant, and hidden), transfusion rate and volume, hemoglobin and hematocrit reduction, duration of operation and anesthesia, length of hospitalization, range of hip motion as well as postoperative complications were collected from hospital's electronic records and compared between groups.ResultsAll patients were followed for more than 3 months. Total blood loss in the two HA groups (1390.25 ± 595.67 ml and 1377.74 ± 423.46 ml, respectively) was significantly reduced compared with that in Std‐GA group (1850.83 ± 800.73 ml, P < 0.001). Both dominant and hidden blood loss were dramatically decreased when HA was applied (both P < 0.001). Accordingly, the transfusion rate along with volume in 70–80 HA group (14.1%, 425.00 ± 128.81 ml) and <70 HA group (12.8%, 340.00 ± 134.16 ml) were reduced in comparison with those in Std‐GA group (37.3%, 690.91 ± 370.21ml; P = 0.001 and P = 0.014, respectively). The maximal hemoglobin and hematocrit reduction in both HA groups were significantly less than those in Std‐GA group (both P < 0.001). Of note, 70–80 and <70 HA groups exhibited comparable efficacy with no significant differences between them. Besides, significant difference in duration of surgery was found among groups (P = 0.044 and P < 0.001), while no differences in anesthesia time and postoperative range of hip motion were observed. Regarding complications, the incidence of both acute kidney injury and postoperative hypotension in <70 HA group was significantly higher than that in 70–80 HA and Std‐GA groups (P = 0.014 and P < 0.001). Incidence of acute myocardial injury was similar among groups (P = 0.099) and no other severe complications or mortality were recorded.ConclusionThe combination of HA with a mean arterial pressure (MAP) of 70–80 mmHg and TXA could significantly reduce blood loss and transfusion during SBTHA, in addition to shortening operation time and length of hospitalization, and with no increase in complications.

Are Functional Outcomes of a Total Hip Arthroplasty Predictive of a Contralateral Total Hip Arthroplasty: A Retrospective Cohort Study.

Current literature suggests that 8%-35% of patients undergoing total hip arthroplasty (THA) undergo a subsequent contralateral THA. This study aims to determine if functional outcomes after primary THA predict outcomes in the subsequent primary THA of the contralateral side. A retrospective cohort of patients undergoing staged bilateral primary THA was reviewed. The Oxford Hip Score (OHS) was utilized as the functional outcome measurement tool and was assessed preoperatively and at one year postoperatively. The minimal clinically important difference (MCID) was assessed. Based on the first-side THA one-year outcomes, the odds of maintaining an MCID, or not, for the second-side THA were determined. The study cohort consisted of 551 patients and 1102 primary THAs. The average postoperative OHSs were similar after the first and second THA. Patients achieving the MCID with the first-side surgery were 2.6 times (95% confidence interval 1.0 to 6.64, P= .04) more likely to achieve the MCID for the second-side surgery than patients failing to reach the MCID for their first-side surgery. After the first THA, 29 (5.3%) patients failed to reach the predefined MCID for the OHS compared with 54 (9.8%) patients undergoing their second THA (odds ratio: 1.96 [95% confidence interval: 1.23 to 3.1], χ2= 8.14, P= .005). Functional outcomes after the first THA are predictive of functional outcomes of the second THA. Patients are more likely to achieve a clinically significant improvement after their first THA related to higher preoperative OHSs before the second THA.