Simultaneous Bilateral Group Research Articles

Midterm Outcomes After Simultaneous Hip Arthroscopic Surgery for Bilateral Femoroacetabular Impingement

Background: Bilateral hip arthroscopic surgery for the treatment of femoroacetabular impingement (FAI) has demonstrated good outcomes at short-term follow-up, with significant improvements in pain, hip function, and patient-reported outcomes, coupled with a complication rate similar to that of unilateral surgery. Purpose: To investigate whether, in patients with bilateral symptomatic FAI, simultaneous bilateral hip arthroscopic surgery is an efficacious option that produces effective midterm outcomes. Study Design: Cohort study; Level of evidence, 3. Methods: A prospective database of patients who underwent primary hip arthroscopic surgery between August 2012 and October 2020 was used to collect clinical data on 2 groups. Group 1 consisted of patients who underwent simultaneous bilateral hip arthroscopic surgery for the treatment of FAI. Group 2 represented a matched-pair control group of patients selected based on sex and age with signs and symptoms of unilateral FAI and in whom a single side was evaluated and treated. Differences in the International Hip Outcome Tool–12 and Non-Arthritic Hip Score scores were evaluated up to 5 years postoperatively. Results: In total, 171 patients (235 hips) were included, of whom 64 underwent simultaneous bilateral hip arthroscopic surgery (128 hips) and a control group of 107 patients (107 hips) underwent unilateral hip arthroscopic surgery. No significant differences were observed in International Hip Outcome Tool–12 scores between the 2 groups at 6 weeks, 3 months, 1 year, 2 years, and 5 years postoperatively. No significant differences were observed in Non–Arthritic Hip Score scores between the simultaneous bilateral and control groups at 6 weeks, 3 months, 6 months, 1 year, 2 years, and 5 years postoperatively. Overall, 18% of hips in the simultaneous bilateral group reported lateral femoral cutaneous nerve palsy at 2-week follow-up in comparison to 16% of hips in the control group. Conclusion: Simultaneous bilateral hip arthroscopic surgery for the treatment of FAI represents a safe treatment option, producing effective midterm outcomes in appropriately selected patients.

Parental Contingent Verbal Response to Early Vocalizations of Simultaneous Bilateral Cochlear Implantees

Objectives: The parental verbal response greatly influences infants’ speech-language development in early communication. This study aimed to investigate the features of parental verbal responses in infants who have undergone simultaneous bilateral cochlear implantation compared to chronological age-matched (CA) and hearing age-matched (HA) children who have typical hearing.Methods: Thirteen pairs of infants with cochlear implants (CIs) and their parents, 13 pairs of CA infants and their parents, and 13 pairs of HA infants and their parents participated in this study. The parent-infant interaction task was conducted in a free-play situation. Infants’ vocalizations were classified into canonical and non-canonical vocalizations. Parental verbal responses were divided into parental contingent responses (PCRs), parental non-contingent responses (PNCRs), and no response (NR). PCRs were divided into the language expectant and language non-expectant responses.Results: There was no significant difference in the ratio of parental verbal responses between the three groups. The ratio of parental verbal responses to non-canonical vocalizations was higher than parental verbal responses to canonical vocalizations. Additionally, the ratio of PCRs was higher than that of PNCRs and NR, and the ratio of language expectant responses was higher than that of language non-expectant responses. However, the ratio of language development responses to non-canonical vocalizations is similar to that of canonical vocalizations in the CI group.Conclusion: Parents of the simultaneous bilateral CI group tend to respond quickly and sensitively to the vocalization of infants’ vocalizations. Parents in the CI group can adjust their language based on their infant’s vocalization and development. These findings can guide early intervention and coaching for parents of infants with CIs.

Comparison study of periprosthetic bone remodeling between simultaneous bilateral total hip arthroplasty and unilateral total hip arthroplasty: a matched cohort study.

The load-bearing pattern of periprosthetic bone may differ between patients who underwent simultaneous bilateral and unilateral total hip arthroplasty (THA). We investigated the differences in periprosthetic bone remodeling after simultaneous bilateral total hip arthroplasty and unilateral total hip arthroplasty. This retrospective cohort study enrolled 154 consecutive patients undergoing THA using full hydroxyapatite (HA) compaction short stems. Patient characteristics including age, body mass index, University of California Los Angeles (UCLA) activity score, and bone shape of the proximal femur were adjusted by propensity score matching. Subsequently, periprosthetic bone mineral density changes were compared between simultaneous bilateral and unilateral THA. We found that bone mineral density loss in the simultaneous bilateral THA group was significantly higher in zones 6 and 7 at 24 months after THA (zone 6, p = 0.019; zone 7, p = 0.041). Periprosthetic bone mineral density loss was not associated with clinical factors, including age, body mass index, and daily activity. Additionally, we demonstrated that periprosthetic bone mineral density loss was higher in zones 1, 4, 6, and 7 of patients with a normal hip on the contralateral side after unilateral THA (zone 1, p = 0.041; zone 4, p = 0.041; zone 6, p = 0.037; zone7, p = 0.019). The postoperative periprosthetic bone remodeling was lower in patients who underwent simultaneous bilateral THA than in those who underwent unilateral THA, even though patient characteristics were adjusted by propensity matching. Further observation of periprosthetic bone mineral density loss is needed to clarify the differences between the groups.

Bilateral simultaneous hip arthroplasty shows comparable early outcome and complication rate as staged bilateral hip arthroplasty for patients scored ASA 1-3 if performed by a high-volume surgeon

PurposeThe aim of this study was to compare early outcomes after simultaneous and staged hip arthroplasty (THA) in patients with bilateral symptomatic pathology.MethodsWe conducted a retrospective cohort study including all patients scheduled for primary THA for bilateral hip osteoarthritis (OA, n = 290). Patients either received simultaneous (n = 152, 52.4%) or staged (n = 138, 47.6%) bilateral THA based on individual preference. All operations (n = 428) were performed by one single, high-volume surgeon. Demographic data (e.g., age, ASA score) as well as perioperative parameters (haemoglobin drop (Hb), red blood cell transfusion, length of stay (LOS), operation time, six week complication rate and achievement of inpatient rehabilitation key points) were evaluated.ResultsPatients in the simultaneous bilateral THA group were younger (62.8 ± 8.9 vs. 65 ± 9.7 years, p = 0.022) and had lower ASA scores (1.8, (34.2% ASA 1, 55.3% ASA 2, 37.2% ASA 3) vs. 2.0 (18.8% ASA 1, 61.6% ASA 2, 19.6% ASA 3)) than the staged group. While the average LOS was 7.1 ± 1.7 days for simultaneous bilateral THA, the combined LOS for the staged group was 12.9 ± 2.4 days (p < 0.001). The cumulative operation time in the simultaneous bilateral THA group was 61.1 ± 11.5 min and 57.6 ± 7.3 min in the staged group (p < 0.015). Cumulative Hb loss was significantly higher in the staged group (2.1 ± 7.2 g/dl vs. 3.7 ± 1.3 g/dl, p < 0.001). No significant differences were found concerning the complication rate or early inpatient rehabilitation.ConclusionSimultaneous bilateral hip arthroplasty in patients with symptomatic bilateral hip osteoarthritis is as safe and successful as a staged procedure if performed by a high-volume surgeon.

Perioperative safety assessment of patients undergoing unilateral or bilateral hip replacements.

Due to the aging of the world population and the increase of obesity rate, it is expected that the number of joint replacement surgery will continue to increase in the next few years. This study evaluated the safety differences between unilateral and bilateral hip replacement surgeries. The data for patients who underwent hip arthroplasty in 2021 and 2022 were examined. The data set included 68 patients who were grouped according to the type of hip replacement needed, sex, age, and body mass index. Total blood loss and operative time were the safety-related indicators used to compare the groups. Regardless of whether the unilateral replacement group was compared with the overall bilateral replacement group or separately with the staged and simultaneous bilateral replacement groups, simultaneous bilateral replacement surgeries were equally safe as the other types of hip replacements. The total blood loss and operative time for the simultaneous bilateral replacement group were not significantly different from those in the unilateral and staged bilateral replacement groups. For overweight patients, the operative time for simultaneous bilateral replacements was significantly shorter than that for unilateral replacements. These findings suggest that for patients requiring bilateral hip replacements, the blood loss risk for patients undergoing simultaneous bilateral hip replacements was similar to that for patients undergoing either unilateral or staged bilateral hip replacements. Thus, simultaneous bilateral total hip replacement (THR) are safe and should be considered for candidate patients.

Younger Age and Left Side Are Risk Factors for Contralateral Trigger Thumb in Children

The metachronism of bilateral trigger thumb (TT) may lead to additional surgery under anesthesia. The aim of this study was to investigate the temporal development of bilateral TT, find risk factors for contralateral TT, and provide evidence for clinical practice. A retrospective analysis was performed on children diagnosed with TT in our hospital from January 2016 to December 2019. Age at onset, laterality, sex, the interval time of onset of contralateral symptoms, age at the time of surgery, and preoperative and postoperative follow-up times were collected. The cases were divided into 3 groups: (1) the unilateral group, (2) the simultaneous bilateral group, and (3) the separate bilateral group. A total of 783 patients with 967 TTs were enrolled. There were 599 (76.5%) cases in the unilateral group, 157 (20.1%) cases in the simultaneous bilateral group, and 27 (3.4%) cases in the separate bilateral group. Seven (0.9%) patients underwent additional surgery on the contralateral side under anesthesia. Of these 7 patients, 6 (85.7%) had left-side onset and 5 (71.4%) patients developed bilateral TT by the age of 4. The mean age at the initial onset in the separate bilateral group was 20.1 months, and the mean age at diagnosis of the contralateral thumb was 33.6 months. Binary logistic regression analysis showed that age and side at initial onset had significant differences ( P =0.043 and 0.000, respectively). Receiver operating characteristic curve analysis showed that the cutoff value of age at initial onset was 16 months. There was a low incidence of metachronous bilateral TT with additional surgery for the contralateral thumb. Age and side at initial onset are risk factors for contralateral TT. Level II; prognostic studies.

Outcomes of simultaneous bilateral total hip arthroplasty for 256 selected patients in a single surgeon's practice.

Total hip arthroplasty (THA) using the direct anterior approach (DAA) is undertaken with the patient in the supine position, creating an opportunity to replace both hips under one anaesthetic. Few studies have reported simultaneous bilateral DAA-THA. The aim of this study was to characterize a cohort of patients selected for this technique by a single, high-volume arthroplasty surgeon and to investigate their early postoperative clinical outcomes. Using an institutional database, we reviewed 643 patients who underwent bilateral DAA-THA by a single surgeon between 1 January 2010 and 31 December 2018. The demographic characteristics of the 256 patients (39.8%) who underwent simultaneous bilateral DAA-THA were compared with the 387 patients (60.2%) who underwent staged THA during the same period of time. We then reviewed the length of stay, rate of discharge home, 90-day complications, and readmissions for the simultaneous bilateral group. Patients undergoing simultaneous bilateral DAA-THA had a 3.5% transfusion rate, a 1.8 day mean length of stay, a 98.1% rate of discharge home, and low rates of 90-day infection (0.39%), dislocation (0.39%), periprosthetic fracture (0.77%), venous thromboembolism (0%), haematoma (0.39%), further surgery (0.77%), and readmission (0.77%). These patients were significantly younger (mean 58.2 years vs 62.5 years; p < 0.001), more likely to be male (60.3% vs 46.5%; p < 0.001), and with a trend towards having a lower mean BMI (27.8 kg/m2 vs 28.4 kg/m2; p = 0.071) than patients who underwent staged bilateral DAA-THA. Patients selected for simultaneous bilateral DAA-THA in a single surgeon's practice had a 3% rate of postoperative transfusion and a low rate of complications, readmissions, and discharge to a rehabilitation facility. Simultaneous bilateral DAA-THA appears to be a reasonable and safe form of treatment for patients with bilateral symptomatic osteoarthritis of the hip when undertaken by an experienced arthroplasty surgeon with appropriate selection criteria. Cite this article: Bone Joint J2021;103-B(7 Supple B):116-121.

Outcomes of Simultaneous Bilateral vs Unilateral Distal Chevron Metatarsal Osteotomy in Hallux Valgus Patients Aged ≥60 Years.

The purpose of this study was to compare radiographic outcomes of simultaneous bilateral and unilateral distal chevron metatarsal osteotomy (DCMO) in hallux valgus patients aged ≥60 years. This retrospective study analyzed consecutive outcomes of simultaneous bilateral DCMO and unilateral DCMO performed between June 2010 and August 2018 in 90 feet of 60 patients. Thirty patients underwent simultaneous bilateral DCMO, and 30 underwent unilateral DCMO. Comparative analysis of radiographic and clinical parameters between a simultaneous bilateral DCMO group (SB) and a unilateral DCMO group (U) was performed. Mean age at surgery (65.7±4.8 vs 65.2±5.2 years), mean length of follow-up period (20.0 vs 18.6 months), and preoperative radiographic parameters were similar between the 2 groups (SB vs U). Mean hallux valgus angle (HVA) improved from 34.2 to 5.4 degrees (correction angle SB 28.8 vs U 28.8 degrees). Mean first-to-second intermetatarsal angle improved from 15.8 to 6.8 degrees (correction angle SB 8.9 vs U 8.9 degrees). Hallux varus deformity was observed in 4 feet (SB 3 vs U 1), and mechanical instability with callus formation in 1 foot in the unilateral group. DCMOs in patients aged ≥60 years were radiographically effective and safe, even performed in one stage bilaterally. Radiographic parameters were similar in patients who underwent simultaneous bilateral and unilateral DCMO. Level III, retrospective cohort study.

Should patients with unresectable gallbladder cancer with hilar involvement undergo unilateral or bilateral percutaneous biliary drainage in the setting of cholangitis?

Aim of the studyThis study aimed to evaluate the outcomes of patients with unresectable gallbladder cancer (GBC) with hilar involvement and cholangitis undergoing percutaneous transhepatic biliary drainage (PTBD).Material and methodsThis retrospective study comprised consecutive patients with unresectable GBC with cholangitis who underwent PTBD. The procedures were categorized as unilateral or bilateral. Bilateral PTBD was classified as simultaneous or sequential. The mean reduction in bilirubin at two weeks was recorded. Complications and mean overall survival were also recorded.ResultsThirty-three patients (mean age 54.5 years, 12 males) were included. Thirty patients underwent unilateral drainage. Sequential drainage of the contralateral system was performed in 11 patients. Simultaneous bilateral PTBD was performed in 3 patients. PTBD was technically successful in all patients. Mean reduction in bilirubin was 41.5% in the unilateral group. The fall of bilirubin in the simultaneous bilateral PTBD group was 39%. The mean follow-up duration was 36.5 days. No major complications were encountered. At the last follow-up, 7 patients were alive. The mean overall survival was 34.6 days.ConclusionsPatients with unresectable GBC and cholangitis frequently require bilateral drainage. However, prospective studies should be performed to evaluate whether a sequential or simultaneous PTBD should be performed.

Bilateral cochlear implantation: simultaneous versus sequential

BackgroundBilateral cochlear implantation (BiCI) has been provided with an intent to promote binaural hearing and improve quality of life (QoL). Binaural hearing maximum benefit could be optimized with BiCI, when indicated in the early stages of life through preserving the cortical hearing development. Actually, BiCI benefits wide variables among patients, and in this work, we aimed to analyze the benefit of bilateral cochlear implantation over unilateral and the simultaneous over sequential implantation in peri- and post-lingual patients. The analysis based on common clinically used audiological tests such as aided hearing threshold and speech perception measures.ResultsThe results of the aided threshold and speech perception measures in all patients revealed a significantly better response in the bilateral implantations than in unilateral each implant separately. Overall, the best response was seen in the simultaneous bilateral group followed by sequential bilateral groups. In post-lingual patients, a better response was observed in sequential and similar bilateral than in sequential and different device groups with significant differences.Change of performance across time revealed aided threshold improvement of the from 3 to 6 months. In speech perception measures, the post-lingual group revealed significant improvement of high-context sentence test (HCST) scores from 3 to 6 months and 12 months. In the peri-lingual group, Early Speech Perception test (ESPT) revealed a change in performance with time at 3, 6, and 12 months. In addition, the simultaneous patient’s scores were significantly better than sequential similar patient’s scores.ConclusionThe main finding of our study was that bilateral cochlear implants (BiCI) are better than unilateral cochlear implant, and simultaneous BiCI is preferred than the sequential cochlear implant even after escaping the early stage of language development.

CRP (C Reactive Protein) level after total knee replacement in Indian population--- does it follow Anglo-Saxon trend?

BackgroundThis study was to determine how C-reactive protein (CRP) responds after total knee replacement (TKR), including both unilateral and simultaneous bilateral TKR in Indian population and if it follows Anglo-Saxon trend. Published literature from North America and Europe shows CRP value peaks on the 2nd post-operative day and drops to normal by 6–8 weeks. We started the study with null hypothesis.Material and methodsThis is a prospective study, with 50 patients (all females, 25 received unilateral operations and 25 bilateral ones) included. CRP levels were measured, on the 2nd day, 8, 12 and 16 weeks after operation.ResultsIn both groups, CRP level rose the 2nd post-operative day. The rise in CRP level was significantly higher in the simultaneous bilateral TKR group than in the unilateral TKR group. In unilateral cases, CRP on the 2nd postoperative day ranged from 65 to 110 mg/l with average level of 80 mg/ml. In bilateral TKR cases, CRP level on the 2nd postoperative day was between 110 and 180 mg/l with a mean of 140 mg/ml. The CRP level returned to normal in about 40% of unilateral TKR patients 8 weeks after operation, while in 92% (23 out of 25) of bilateral simultaneous TKR patients it stayed at a high level 8 weeks post-op and did not come back to normal. At 12 weeks CRP decreased to normal in all 100% of unilateral TKR patients and 32% of bilateral TKR patients. At 16 weeks, CRP was normal in all bilateral TKR patients.Conclusion60% of our unilateral TKR patients and 92% of our simultaneous bilateral TKR patients did not achieve a normal CRP 8 weeks after operation. These findings are significant as CRP is commonly used as a very sensitive indicator of postoperative joint infection. Hence we conclude that in the Indian TKR patients the CRP values take longer time to return to normal than in their Anglo-Saxon counterparts. Published results regarding the normal levels of CRP in unilateral TKR should not be extrapolated to simultaneous bilateral TKR patients.

Does Body Mass Index Cause a Clinical Difference in Simultaneous Bilateral and Unilateral Knee Arthroplasty?

This study aims to investigate clinical and functional factors in patients undergoing unilateral and simultaneous bilateral total knee arthroplasty (TKA) who were classified into subgroups of nonobese, obese, and morbidly obese, and to determine perioperative and postoperative complications. We conducted an evaluation of 489 nonobese, obese, and morbidly obese patients who underwent TKA due to primary knee osteoarthritis between January 2006 and December 2013. The arthroplasties were performed by three different surgeons. Patients who underwent unilateral (group 1) or simultaneous bilateral (group 2) TKAs were divided into subgroups in accordance with BMI levels, that is, (a) nonobese (BMI < 30 kg/m2), (b) obese (BMI = 30-34.9 kg/m2), and (c) morbidly obese (BMI ≥35 kg/m2). Clinical and functional assessments were performed using Knee Society Scores (KSSs), the Western Ontario and McMaster Universities Osteoarthritis index (WOMAC), and range of motion (ROM) values. Perioperative and early postoperative complications were assessed. The mean follow-up period was 46.65 months (minimum: 24 months; maximum: 84 months). There were no significant differences between the patients undergoing unilateral or simultaneous bilateral TKA procedures regarding postoperative ROM, WOMAC indices, and KSSs (p > 0.05), except for morbidly obese patients. Most intraoperative and early postoperative complications occurred in the morbidly obese group, especially in those undergoing simultaneous bilateral TKA procedures (p < 0.001). Unilateral and simultaneous bilateral TKA procedures showed no differences regarding ROM, clinical scores, and perioperative and early postoperative complications in nonobese and obese patients. A moderate increase was detected in complication rates in the unilateral TKA morbidly obese patients (group 1c); however, morbidly obese patients constituted the major risk group in simultaneous bilateral TKA patients (group 2c) regarding clinical scores (lower WOMAC scores and KSSs) and the development of complications.

UNILATERAL VERSUS SIMULTANEOUS BILATERAL PERCUTANEOUS HALLUX VALGUS SURGERY

Introduction: The purpose of the present study is to evaluate the clinical and radiographic results of simultaneous surgical correction for bilateral hallux valgus compared with unilateral correction using percutaneous forefoot surgery techniques (PFS). Material and Methods: A prospective cohort study of 82 patients (106 feet). The mean follow-up was 58.7[Formula: see text][Formula: see text][Formula: see text]1.5 months (range 22.3 to 112.1). Patients were divided into two groups, unilateral surgical group (group U, 58 feet) and simultaneous bilateral surgical group (group B, 48 feet). Results: Preoperative mean visual analog scale (VAS) was 6.2 points in group U and 6.3 in group B ([Formula: see text]), at the last follow-up it decreased in both groups (1.6 group U and 1.8 group B, [Formula: see text]). AOFAS score improved from approximately 50 points preoperative in both groups, to 88 at the last follow-up. Mean hallux valgus angles in groups U and B changed from 34.7[Formula: see text] and 34.3[Formula: see text] preoperatively ([Formula: see text]), to 21.3[Formula: see text] and 22.4[Formula: see text] follow-up, respectively ([Formula: see text]). With the numbers available, no significant inter-group differences were observed in clinical and radiographic outcomes. Conclusions: PFS is a valid procedure for outpatient simultaneous surgical correction in patients with bilateral hallux valgus. Level of Evidence: II Prospective Comparative Cohort Study.

Comparison of patient satisfaction after unilateral or simultaneous bilateral total hip arthroplasty through a direct anterior approach: Evaluation using the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire

The aim of this study was to compare patients' perception of treatment outcome after unilateral or simultaneous total hip arthroplasty (THA) using the newly developed Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ). This study included 429 patients treated with primary THA using a direct anterior approach, namely 304 cases of in the unilateral THA (58 males and 246 females; mean age, 62.3 years) and 125 cases of in the simultaneous bilateral THA (24 males and 101 females; mean age, 58.3 years). Items for evaluation included clinical outcomes and all four aspects of the JHEQ score, namely visual analog scale (VAS), pain, movement, and mental status. The mean operative time per hip was 51.3±19.4min (range, 22-180min) in unilateral group and 46.2±15.1min (range, 26-106min) in simultaneous bilateral group. The mean operative blood loss per hip was 421.2ml±232.1ml (range, 70-1300ml) in unilateral group and 200.8±149.8ml (range, 30-1040ml) in simultaneous bilateral group. The total JHEQ score (pain/motion/mental status) improved from 26.5±13.6 (preoperative, 10.1/6.8/9.6) to 69.4±14.8 (1 year postoperatively, 25.1/20.5/23.8) in unilateral group and from 21.0±8.2 (preoperative, 11.9/2.3/6.9) to 74.9±9.5 (1 year postoperatively, 27.2/22.6/25.0) in simultaneous bilateral group. These results demonstrated a significant improvement before and after surgery for patients in both groups. There were not major complications such as dislocation, bone fracture, nerve palsy or symptomatic pulmonary embolism were observed. In this study, we observed greater improvement in JHEQ in patients treated with bilateral simultaneous THA than in those treated with unilateral THA. These findings demonstrated that bilateral simultaneous THA was related to high patient satisfaction as well as high safety.

Simultaneous bilateral stereotactic procedure for deep brain stimulation implants: a significant step for reducing operation time.

OBJECT Currently, bilateral procedures involve 2 sequential implants in each of the hemispheres. The present report demonstrates the feasibility of simultaneous bilateral procedures during the implantation of deep brain stimulation (DBS) leads. METHODS Fifty-seven patients with movement disorders underwent bilateral DBS implantation in the same study period. The authors compared the time required for the surgical implantation of deep brain electrodes in 2 randomly assigned groups. One group of 28 patients underwent traditional sequential electrode implantation, and the other 29 patients underwent simultaneous bilateral implantation. Clinical outcomes of the patients with Parkinson's disease (PD) who had undergone DBS implantation of the subthalamic nucleus using either of the 2 techniques were compared. RESULTS Overall, a reduction of 38.51% in total operating time for the simultaneous bilateral group (136.4 ± 20.93 minutes) as compared with that for the traditional consecutive approach (220.3 ± 27.58 minutes) was observed. Regarding clinical outcomes in the PD patients who underwent subthalamic nucleus DBS implantation, comparing the preoperative off-medication condition with the off-medication/on-stimulation condition 1 year after the surgery in both procedure groups, there was a mean 47.8% ± 9.5% improvement in the Unified Parkinson's Disease Rating Scale Part III (UPDRS-III) score in the simultaneous group, while the sequential group experienced 47.5% ± 15.8% improvement (p = 0.96). Moreover, a marked reduction in the levodopa-equivalent dose from preoperatively to postoperatively was similar in these 2 groups. The simultaneous bilateral procedure presented major advantages over the traditional sequential approach, with a shorter total operating time. CONCLUSIONS A simultaneous stereotactic approach significantly reduces the operation time in bilateral DBS procedures, resulting in decreased microrecording time, contributing to the optimization of functional stereotactic procedures.

Postoperative Complications and Cost-effectiveness of Simultaneous and Staged Bilateral Total Hip Arthroplasty Using a Modified Minimally Invasive Two-incision Technique

PurposeTo compare the postoperative complications and cost-effectiveness of simultaneous and staged bilateral total hip arthroplasty (THA), using a minimally invasive two-incision technique.Materials and MethodsAll 206 patients who underwent simultaneous or staged bilateral THA using a modified, minimally invasive two-incision between January 2004 and November 2009 were registered and divided into a simultaneous bilateral THA group (group A, 147 patients) and staged bilateral THA group (group B: 59 patients). Staged THA was performed on group B with interval of at least 2 months between the initial and second surgery. Clinical evaluations, amount of blood loss, need for transfusion, complications and costeffectiveness were compared.ResultsPerioperative morbidity rates were similar in the two groups (P=0.546) and overall complications were not significant between the groups. Average length of hospital stay was significantly shorter in group A than in group B (average 14.6 days vs. 25.3 days; P<0.001). Total medical cost was significantly higher in group B than in group A (average 9,236 US dollars vs. 11,163 US dollars). Patients in group A required more blood transfusions than those in group B (3.02 vs. 1.90 units; P=0.003), although blood loss in the two groups were similar (892 vs. 917 ml P=0.613).ConclusionComparison of intra- and postoperative complications support the conclusion that simultaneous bilateral THA compares favorably with staged THA in terms of outcomes, complications and cost-effectiveness.

The safety and efficacy of simultaneous or staged bilateral total knee arthroplasty in treatment of both knee osteoarthritis

Objective To compare the clinical safety and efficacy of simultaneous bilateral total knee arthroplasty (TKA) and staged bilateral TKA in treatment of both knee osteoarthritis.Methods A total of 119 patients (14 males,105 females) with both knee osteoarthritis who underwent TKA from March 2005 to March 2012 were retrospectively analyzed.Their ages ranged from 30 to 81 years with the average age of 65.23±6.33 years.The patients were divided into three groups according to different treaments:simultaneous bilateral TKA group,staged bilateral TKA group during the same hospitalization period and staged bilateral TKA group in two separate hospitalization periods.All the procedures were performed by the same surgeons and the same type of prostheses (LPS-Flex,Zimmer,US) were implanted.Differences of preoperative factors (age,height,body mass in dex and complications),treatment factors (preoperative hemoglobin,operation time,drainage volume,blood transfusion volume,total hospitalization time and total hospitalization costs) and postoperative curative effects (HSS scores,WOMAC scores and ROM)among three groups were compared.The analysis of viariace,LSD-t test and x2 test were used for data analysis.Results The differences of gender composition,body mass index,preoperative hemoglobin were not statistically significant among three groups (P＞0.05).The patientsin simultaneous bilateral TKA group were younger,and havelower incidence ofpreoperative complications (P＜0.05).The differences of post-operative HSS scores,WOMAC scores and ROM were not statistically significant among the three groups (P＞0.05).Although the total hospitalization time,operation time were shorter,and the hospitalization costs were significant ly lower in simultaneous bilateral TKA group,the total drainage volume,the total blood transfusion volume and incidence of postoperative complication rate were higher in this group than those of the other two grops (P＜0.05).Conclusion Due to great impact on patients' physiological conditions,more postoperative complication occurrence and high risk of periprosthetic infection,the decision of simultaneous bilateral TKA should be made cautiously. Key words: Osteoarthritis; Arthroplasty, replacement, knee; Comparative study

Simultaneous bilateral anterior cruciate ligament reconstruction: Cost comparison and functional results

Background : The ideal treatment for patients presenting with bilateral anterior cruciate ligament (ACL) deficiency remains controversial. The purpose was to evaluate cost and mid-term functional results after one-stage bilateral ACL reconstruction using either hamstring or patella tendon autograft. Methods : We compared the mid-term outcome of 7 patients (14 knees) who had one-stage bilateral ACL reconstruction with that of a matched group of patients who had unilateral reconstruction (21 patients). Results : The median duration of hospital stay was 4 nights (range 3 to 5) for the bilateral group and 2 nights (range, 1 to 4) for the control group. The duration of rehabilitation process in patients from the control group with unilateral ACL reconstruction was one week shorter (9 versus 8 weeks). In the bilateral group, the median Lysholm score was 96 (range 85–100) and in the control group, the median score was 93 (range 81–100). The median time to return to full-time work and to full sports was 9 weeks and 7 months for the simultaneous bilateral group and 8 weeks and 6 months for the unilateral group. Six patients (86 %) in the bilateral group and 17 patients (81 %) in the control group were still performing at their pre-injury level of activity. The Health Insurance Institute of Slovenia saves EUR 2,925 when we perform simultaneous bilateral ACL reconstruction instead of two stage ACL reconstruction. Conclusions : Mid-term clinical results suggested that simultaneous bilateral ACL reconstruction using either hamstring or patella tendon autograft is clinically effective. For patients presenting with symptomatic bilateral ACL deficient knees, one stage bilateral ACL reconstruction is reproducible, cost effective, and does not compromise functional results.

Costs of staged versus simultaneous bilateral total knee arthroplasty: a population-based study of the Taiwanese National Health Insurance Database

Bilateral total knee arthroplasty (TKA) is required for many patients. There are few studies comparing the overall costs of staged and simultaneous bilateral TKA. The Taiwan National Health Insurance Research Database (NHIRD) was searched, and the total medical costs of 452 patients who received simultaneous bilateral TKAs were compared with those of 690 who received staged bilateral TKAs. All categories of medical costs were lower in the simultaneous TKA group, with the exception of therapeutic procedure fees which were higher in the simultaneous bilateral TKA group. The 10-year prosthesis survival rates for simultaneous and staged bilateral TKA were 90.9% and 87.5% (p > 0.05), respectively. These results indicate that simultaneous bilateral TKA is more cost effective than staged bilateral TKA. Prosthesis survival is not affected by the choice for staged or simultaneous bilateral TKA.

Comparison of Postoperative Morbidity Between Simultaneous Bilateral and Staged Bilateral Total Knee Arthroplasties: Serological Perspective and Clinical Consequences

The present study compared simultaneous and two-staged (stages 1 and 2 with 8-month interval on average) bilateral TKAs in terms of postoperative serological status and clinical consequences. The decrease in hemoglobin over 2 weeks postoperatively was similar between groups. C-reactive protein levels and creatine phosphokinase index peaking on day 2 were significantly higher in the simultaneous group than in either staged group (P<0.05). Incidence of DVT on day 7 tended to be higher in the simultaneous group, but the difference was not significant. Considering the approximately 8-month interval and 2-month earlier functional recovery with stage 2 TKAs, 6 months were saved with the simultaneous bilateral TKA group. Collectively, simultaneous bilateral TKA is likely to offer a safe and effective procedure in appropriate clinical settings involving anti-bleeding and anti-venous thromboembolism prophylaxis.