Simultaneous Bilateral Total Hip Arthroplasty Research Articles

Simultaneous vs staged bilateral hip arthroplasty: monocentric analysis of satisfaction rate and complications.

Interest in bilateral total hip arthroplasty (THA) has been increasing over the past decade. This study aims to compare postoperative local and systemic complications, hospital readmissions, and satisfaction assessment in patients undergoing simultaneous versus staged bilateral THA. A retrospective observational study was conducted among patients who underwent simultaneous or staged bilateral THA between 2017 and 2020. Data on perioperative parameters, local and systemic complications, and 30-day hospital readmissions were collected. Patient satisfaction was assessed using Forgotten Joint Score (FJS). The comparison of continuous variables with normal distribution of variance was performed by ANOVA; for variables with abnormal distribution, the nonparametric test Mann-Whitney U was adopted. The distribution of dichotomous variables was analyzed by chi-square test, and statistical significance was calculated by Fisher exact test. The study included 199 patients, of whom 156 underwent staged and 43 simultaneous bilateral THA. A total of 44 patients developed complications (21 systemics, 12 locals, and 20 postoperative anemia). There were no significant differences regarding local (simultaneous 5% vs. staged 6%; p = 0.999) or systemic complications (simultaneous 14% vs. staged 10%; p = 0.408). Only the incidence of postoperative anemia was significantly higher in simultaneous group compared with staged group (p = 0.003).There were no significant differences in FJS between the two groups (p = 0.258). No differences in local or systemic complications nor readmission rates were observed following simultaneous or staged bilateral THA. Simultaneous bilateral THA is non-inferior to staged implants in terms of safety and patient satisfaction.

Delta hemoglobin cutoffs do not predict readmission in patients undergoing primary simultaneous bilateral total hip or knee arthroplasty: A retrospective cohort study

Delta hemoglobin cutoffs do not predict readmission in patients undergoing primary simultaneous bilateral total hip or knee arthroplasty: A retrospective cohort study

To Stage or Not to Stage? Comparison of Patient-Reported Outcomes, Complications, and Discharge Disposition After Staged and Simultaneous Bilateral Posterior Total Hip Arthroplasty

BackgroundPatients who have bilateral hip arthritis can be treated with bilateral total hip arthroplasty (bTHA) in either a staged or simultaneous fashion. The goal of this study was to determine whether staged and simultaneous posterior bTHA patients differ in regard to (1) patient-reported outcome measures, (2) 90-day complication rates, and (3) discharge dispositions and cumulative lengths of stay. MethodsPatients who (1) underwent simultaneous bTHA or staged bTHA (within 12 months) using the posterior approach, and (2) completed preoperative and 1-year postoperative Hip dysfunction and Osteoarthritis Outcome Score for Joint Replacement surveys were included in the study. A total of 266 patients (87 simultaneous bTHA and 179 staged bTHA) were included. Chart review was performed to collect patient-level variables, postoperative complications, discharge dispositions, and lengths of stay. ResultsStaged bTHA patients had higher Hip dysfunction and Osteoarthritis Outcome Score for Joint Replacement, Lower Extremity Activity Scale, and Veterans RAND 12-Item Health Survey physical component scores compared to simultaneous bTHA patients at 6 weeks after surgery (P = .019, .006, and .008, respectively), but these differences did not meet the minimal clinically important difference threshold for any questionnaire. Simultaneous bTHA was associated with higher rate of periprosthetic fractures (P = .034) and discharge to a location other than home (P < .001). ConclusionsThere were statistically significant, but likely not clinically meaningful differences in patient-reported outcomes for staged and simultaneous bTHA patients at 6 weeks after surgery. Surgeons should be aware of the higher periprosthetic fracture risk and greater likelihood of discharge to a rehabilitation facility associated with simultaneous bTHA. Further research should aim to understand which patients may benefit most from simultaneous bTHA.

Unilateral versus simultaneous bilateral total hip arthroplasty. The Belgian experience.

A retrospective data analysis was performed on 468 patients who underwent either UTHA (418 patients) or SBTHA (50 patients) using a direct anterior approach between June 2016 and December 2020. Apart from SBTHA patients being significantly younger, there was no significant preoperative difference in demographics, comorbidities, surgical variables and biological values between the two groups. Primary outcomes were 90-days emergency room (ER) visit and readmission, as well as 90-days minor and major complications. Secondary outcomes were length of stay (LOS), operative time and blood loss. 90-days ER visit (p=0.244), 90- days readmission (p=0.091), overall complications rate (p=0.376), minor complications (p=0.952) and major complications (p=0.258) were not statistically different between the two groups. Operative time and average LOS were significantly longer in the SBTHA group (p<0.001). Blood loss was significantly higher (p<0.001) in the SBTHA group. However, no difference in the transfusion rate between the two groups was observed (p=0.724). Complication rate, 90- days hospital readmission and 90-days ER visit were similar between the two groups. This study shows that performing SBTHA is a safe, effective, and doesn't carry additional risks for patients with bilateral symptomatic osteoarthritis.

Functional and Radiological Outcomes Following Simultaneous Bilateral Total Hip Arthroplasty: Analysis of a Retrospective Series.

Introduction The prevalence of bilateral hip arthritis continues to rise. With the dramatic change in the practice of modern-day arthroplasty with standard operating protocols and guidelines in place to reduce the incidence of surgical site infection and peri-operative thromboembolic events, simultaneous bilateral total hip replacement (THR) has been considered a viable option to reduce morbidity. The efficacy of simultaneous bilateral THR with regardto patient outcomes and complications has been debated. The aim of this study was to assess and compare the functional outcomes, radiological outcomes, and complications following bilateral simultaneous THR with the existing literature. Methods We conducted a retrospective study of 28 patients who underwent simultaneous bilateral THRby a single surgeon at a district general hospital in the United Kingdom between 2010 and 2019. All the patients in the study were operated on via the posterior approach to the hip and received uncemented implants. Data on blood loss and hospital stay were collected from the hospital records. The radiological outcomes were studied from the post-operative radiographs. The patient-reported outcomes were measured via a telephone session at an average follow-up of 7.8 years. Results Our results noted a statistically significant drop in haemoglobin after the procedure from a mean of 13.5 g/dl to 9.05 g/dl (t: -15.84, p < 0.00001). The average blood loss was 643 ml +/- 330 ml (200-1850 ml). Nine patients (32.1%) required blood transfusions and a total of 21 units were transfused. The mean duration of stay in the hospital was 6.7 days (three to 20 days). There were no intra-operative/immediate/early post-operative complications. The revision rate was 1.7%, as one patient had a revision of the femoral component following a peri-prosthetic fracture. The mean visual analogue scale painscore was 1.51 +/- 0.58 (1-3). The mean Oxford Hip Score improved from 19.5 (12-28) pre-operatively to 44.3 (37-48) post-operatively at the time of the study (t: -21.88945; p < 0.00001), with the difference being statistically significant using a paired t-test. From the series, 14 (50%) patients were found to have limb length discrepancies. The mean limb length discrepancy was found to be 2.3 mm (0-16 mm). In 13 of the 28 patients (46.4%), the global hip offset was equal on both sides.In two patients, the difference in the global hip offset was more than 10 mm. Conclusion We reported good patient-reported functional outcomes with simultaneous bilateral THR with a low complication rate. Despite the lack of opportunity to template the second hip, the limb length and global hip offset can be restored after a simultaneous bilateral THR.

Dexamethasone as additive of local infiltration analgesia reduces opioids consumption after simultaneous bilateral total hip or knee arthroplasty: a randomized controlled double-blind trial

PurposeA randomized controlled double-blind trial was conducted to evaluate the effects of adding dexamethasone to the local infiltration analgesia (LIA) mixture on frequency of patient controlled analgesia (PCA) and opioids consumption after simultaneous bilateral total hip or knee arthroplasty (THA or TKA).Methods108 patients who received simultaneous bilateral THA or TKA were randomly divided into dexamethasone group and normal saline (NS) group. The main difference between two groups was whether or not dexamethasone was added to the LIA mixture. The main outcome was the cumulative consumption of opioids within 24 h. The secondary outcome were the total cumulative consumption of opioids during postoperative hospitalization, consumption of opioids drug for rescue analgesia, frequency of PCA, postoperative Visual Analogue Scale (VAS), and complications.ResultsCumulative consumption of opioids in the 24 h was similar between two groups (P = 0.17). Total cumulative consumption of opioids in the dexamethasone group during postoperative hospitalization was significantly lower (P = 0.03). No significant difference in the consumption of opioids drug for rescue analgesia between two groups within 24 h, while the frequency of PCA was significantly different (P = 0.04). VAS of dexamethasone group and NS group were similar during postoperative hospitalization, while the incidence of postoperative nausea and vomiting (PONV) in dexamethasone group was lower than that in NS group.ConclusionsAdding dexamethasone to LIA in the simultaneous bilateral THA or TKA can effectively reduce the total cumulative consumption of opioids and the frequency of PCA, as well as reduce the incidence of PONV.Trial Registration The trial has been registered in the Chinese Clinical Trial Registry (Registration Number: ChiCTR2100042551, Date: 23/01/2021).

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.

Simultaneous bilateral versus unilateral total hip arthroplasty: Pain and physical function in a one- and five-year follow-up - retrospective patients record study

BackgroundTotal hip arthroplasty (THA) decreases pain and improves function in patients with osteoarthritis. In some cases, both hips have been operated simultaneously. Our aim was to report patients’ pain and physical function after one- and five-years post-operatively among patients who underwent unilateral THA and those who underwent bilateral THA at the same time in one orthopaedic hospital in Finland.MethodsThe study group consisted of 488 patients retrospectively selected patients from a single centre; 421 of them underwent unilateral THA and 67 underwent simultaneous bilateral THA. The patients had two clinical examinations one and five years postoperatively. Systematic data about pain and physical function were collected using the scaled Orton Hip Score (sOHS). Register data on revisions and mortality events were from the Finnish Institute of Health and Welfare.ResultsAt the one-year follow-up, total sOHS was improved remarkably from the preoperative situation, both in the unilateral THA (age and gender adjusted mean improvement 42 points (95% CI: 40 to 44, p < 0.001) and in the bilateral THA groups (age and gender adjusted mean improvement 45 [95% CI: 41 to 49], p < 0.001), with no group differences after five-years of operation (age and gender adjusted p = 0.19). Total sOHS was statistically higher in the bilateral THA compared to the unilateral THA after one year (98 vs. 95, p < 0.001) and five years (97 vs. 95, p = 0.003) of operation.ConclusionsPatients in unilateral THA and bilateral THA groups had increased their physical function, and pain had decreased after one-year follow-up of the primary THA operation, and condition remained after five years of operation. At follow-ups, patients who underwent bilateral THA had slightly better physical function compared to patients who underwent unilateral THA at follow-up; however, this difference had no clinical relevance.

Increased Complication Risk Associated With Simultaneous Bilateral Total Hip Arthroplasty: A Contemporary, Matched Cohort Analysis

BackgroundSimultaneous bilateral total hip arthroplasty (sbTHA) continues to be performed in patients who have bilateral end-stage osteoarthritis. However, few studies have evaluated the risk associated with this practice compared to unilateral total hip arthroplasty (THA). MethodsUsing a large national database, primary, elective sbTHAs, and unilateral THAs were identified from January 1, 2015 to December 31, 2021. The sbTHAs were matched to unilateral THAs at a 1:5 ratio on age, sex, and pertinent comorbidities. Patient characteristics and comorbidities, and hospital factors were compared between both cohorts. Additionally, 90-day risk of postoperative complications, readmissions, and in-hospital deaths were assessed. After matching, 2,913 sbTHAs were compared to 14,565 unilateral THAs with an average age of 58.5 ± 10.0 years. ResultsCompared to unilateral patients, sbTHA patients demonstrated higher rates of pulmonary embolism (PE) (0.4 versus 0.2%, P = .002), acute renal failure (1.2 versus 0.7%, P = .007), acute blood loss anemia (30.4 versus 16.7%, P < .001), and need for transfusion (6.6 versus 1.8%, P < .001). After accounting for confounders, sbTHA patients demonstrated increased risk of PE (adjusted odds ratio [aOR]: 3.76, 95% CI: 1.84 to 7.70, P < .001), acute renal failure (aOR: 1.83, 95% CI: 1.23 to 2.72, P = .003), acute blood loss anemia (aOR: 2.3, 95% CI: 2.10 to 2.53, P < .001), and transfusion (aOR: 4.08, 95% CI: 3.35 to 4.98, P < .001) compared to unilateral THA patients. ConclusionThe practice of performing sbTHA was associated with an increased risk of PE, acute renal failure, and risk of transfusion. Careful evaluation of patient-specific risk factors is warranted when considering these bilateral procedures.

A NSQIP Analysis of Complications after Simultaneous Bilateral Total Hip Arthroplasty

AbstractSimultaneous bilateral total hip arthroplasty (blTHA) offers the benefit of a single episode of care with the potential for lower cumulative operative times and rehabilitation periods than staged bilateral total hip arthroplasty (stTHA). This study analyzes short-term complication rates after blTHA relative to unilateral THA (ulTHA) and projected stTHA in patients with bilateral hip osteoarthritis. We compared complications in a simultaneous blTHA group and a ulTHA group using the National Surgical Quality Improvement Program (NSQIP) database. ulTHA patients were propensity-matched two-to-one against blTHA patients using morbidity probability score. Thirty-day complication rates were compared. Outcomes in staged procedures (stTHA) were projected by doubling complication rates in ulTHA procedures. There were 805 blTHA patients and 1,610 ulTHA patients used to estimate stTHA outcomes. The rate of major complications or death after blTHA was no higher than the projected stTHA rate (2.0 vs 3.0%, p = 0.179), but minor complications were more common after blTHA than stTHA projections (13.5 vs 6.8%, p &lt; 0.001). Mean operative time for blTHA was 39.2 minutes shorter than that for stTHA (p &lt; 0.001); mean hospital stay was 1 day shorter for blTHA than that for stTHA (p &lt; 0.001). Thirty-day rates of periprosthetic fracture (0.62 vs 0.12%, p = 0.045) and dislocation (0.50 vs 0.1%, p = 0.1) were higher after blTHA than stTHA. Simultaneous blTHA appears safe in patients medically fit to tolerate longer uninterrupted surgery and appears to shorten operative time and hospital stay relative to staged THA. There is a significantly higher risk of blood transfusion, periprosthetic fracture, and dislocation after blTHA.

Comparison of simultaneous versus staged bilateral total hip arthroplasty via the direct anterior approach: A propensity score matched analysis.

It remains unclear whether simultaneous bilateral total hip arthroplasty (SimBTHA) or staged bilateral total hip arthroplasty (StaBTHA) is clinically superior. No study has compared these two procedures matching surgical approach and patient background. This study aimed to clarify the differences between SimBTHA using direct anterior approach (SimBTHA-DAA) and StaBTHA using the direct anterior approach (StaBTHA-DAA). Patients who underwent THA between 2012 and 2020 were enrolled, resulting in a total of 1658 hips of 1388 patients. After propensity score matching for patient background, 204 hips of 102 patients (51 patients in each group) were examined. Clinical and radiographic outcomes, complications, intraoperative blood loss and blood transfusions (BT) were evaluated. In complications, we evaluated periprosthetic fractures, pulmonary embolism, deep venous thrombosis, surgical site infection and dislocation. At the final follow-up, clinical and radiographic outcomes and complications were not significantly different between the groups. Intraoperative blood loss was equivalent for SimBTHA and the sum in the first- and second-stage StaBTHA. The total-BT rate was significantly higher for SimBTHA-DAA than for StaBTHA-DAA (p < .0001). The allogeneic BT rate was significantly higher in SimBTHA-DAA in the supine position (32.3%) than in StaBTHA-DAA (8.3%) (p = .007). However, no patient who received autologous BT required allogeneic BT. Clinical and radiographic outcomes were equivalent between SimBTHA-DAA and StaBTHA-DAA. The allogeneic BT rate was significantly higher in SimBTHA-DAA than in StaBTHA-DAA. Autologous BT reduced the use of allogeneic BT in SimBTHA-DAA. Auto-BT may be useful for avoiding allo-BT in SimBTHA.

Comparison of postoperative outcomes between bikini-incision via direct anterior approach and posterolateral approach in simultaneous bilateral total hip arthroplasty: a randomized controlled trial

The purpose of this study was to compare an oblique bikini-incision via direct anterior approach (BI-DAA) to a conventional posterolateral approach (PLA) during simultaneous bilateral total hip arthroplasty (simBTHA) in terms of early patient outcomes, postoperative functional recovery, and complications. From January 2017 to January 2020, 106 patients receiving simBTHA were enrolled and randomly allocated to the BI-DAA or PLA group. Primary outcomes were measured using hemoglobin (HGB) drop, transfusion rate, the length of stay (LOS), the visual analog scale (VAS) for pain, the Harris hip score, Western Ontario and McMaster Universities Osteoarthritis Index, and the scar cosmesis assessment and rating scale. Secondary outcomes were the operative time, radiographic measurements, including femoral offset, femoral anteversion, stem varus/valgus angle, and leg length discrepancy (LLD). The occurrence of postoperative complications was also recorded. There were no differences in demographic or clinical characteristics before surgery. Compared to the PLA, the patients in the BI-DAA group had lower HGB drop (24.7 ± 13.3 g/L vs. 34.7 ± 16.7, P < .01) and transfusion rates (9/50 vs. 18/50, P = .04) and a shorter LOS (5.12 ± 1.5 vs. 6.40 ± 2.0 days, P < .01) without increasing the operative time (169.7 ± 17.3 vs. 167.5 ± 21.8 min, P = .58). The BI-DAA group yielded a smaller LLD (2.1 ± 2.3 vs. 3.8 ± 3.0 mm, P < .01) and less variability in component orientation than the PLA group (100% vs. 93%, P = .01). As for the scar, the BI-DAA group produced a shorter incision length (9.7 ± 1.6 vs. 10.8 ± 2.0 mm, P < .01) and higher postoperative recovery satisfaction than the PLA group. Furthermore, the BI-DAA group had a reduced VAS score one week after surgery and had better functional recovery in three months postoperatively. The BI-DAA group had a higher incidence of LFCN dysesthesia (12/100 vs. 0/100 thighs, P < .01), while other complications did not differ significantly between the two groups. For simBTHA, the bikini incision offers early recovery, less variance in components orientation, better postoperative outcomes, and scar healing than the PLA. Therefore, the bikini incision could be a safe and feasible option for simBTHA recipients.

Simultaneous Bilateral Total Hip Arthroplasty with Straight-Stems and Short-Stems: Does the Short One Do a Better Job?

Total hip arthroplasty (THA) is known to be the most successful orthopaedic surgery of the last century, but it is still struggling with controversies concerning one-stage bilateral THA. The current study aimed to compare the clinical outcome of patients with unilateral or simultaneous bilateral THA by using short-stem and straight-stem designs and focusing on operation time, blood loss, and length of hospital stay (LOS). Between 2006 and 2018, 92 patients were enrolled in this study. Forty-six patients underwent a bilateral THA in one session, and forty-six matched patients underwent a unilateral THA. In each of the two groups (unilateral vs. bilateral), 23 patients received either a straight (unilateral: 10 females, 13 males, mean age 63; bilateral: 12 females, 11 males, mean age 53 years) or short stem (unilateral: 11 females, 12 males, mean age 60 years; bilateral: 12 females, 11 males, 53 mean age 62 years). The blood count was checked preoperatively as well as one and three days after surgery. Furthermore, the operation time and LOS were investigated. Compared to THA with straight-stems, short-stem THA showed significantly less blood loss; there was no difference in the LOS of both groups. A significantly shorter operative time was only observed in the bilateral THA. The current study showed that simultaneous bilateral THA appears to be safe and reliable in patients without multiple comorbidities. In addition, short-stem THA appears to be beneficial in terms of clinical performance and outcome, and it appears to be superior to straight-stem THA, regardless of whether the patient underwent unilateral or simultaneous bilateral THA.

Comparison of Perioperative Outcomes and Early Complications Between a Direct Anterior Approach or Posterolateral Approach in Simultaneous Bilateral Total Hip Arthroplasty: A Retrospective Study.

Background: Controversies remain on the best surgical approaches for unilateral total hip arthroplasty (THA). There are little data on simultaneous bilateral THA via direct anterior approach (SimBDAA-THA) or posterolateral approach (SimBPA-THA). Purpose: We sought to assess differences in perioperative outcomes and early medical and surgical complications between SimBDAA-THA and SimBPA-THA. Methods: This retrospective study involved patients who underwent either SimBDAA-THA in a supine position (n = 73) or SimBPA-THA in a lateral position (n = 162) at our institution from January 2015 to November 2021. The 2 groups were compared in terms of clinical and demographic characteristics, surgical parameters, and complications during 6-months of follow-up. Results: There were no differences in clinical and demographic characteristics between the 2 groups prior to surgery. Simultaneous bilateral THA via direct anterior approach significantly shortened the length of both the operation (117.50 ±19.42 vs 143.97 ± 32.20 min) and the hospitalization (140.64 ± 43.22 vs 156.24 ± 56.64 h) but increased perioperative loss of hemoglobin (3.28 ± 1.01 vs 3.21 ± 2.26 g/dL). There were no significant differences between the two groups in transfusion rate; levels of interleukin-6, C-reactive protein or creatine kinase; or complications. Conclusion: This retrospective study of patients at a single institution found minimal differences in perioperative outcomes or early medical and surgical complications between SimBDAA-THA and SimBPA-THA except operative time and length of hospitalization. Larger studies with longer follow-up should be conducted to identify whether a direct anterior approach is superior to a posterolateral one.

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

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.

Perioperative Operating Room Efficiency Can Make Simultaneous Bilateral Total Hip Arthroplasty Cost-effective: A Proposal for a Value-sharing Model.

Increasing demand for total hip arthroplasty (THA) and rising health-care costs have led hospitals to improve operating room (OR) efficiency. We compare the cost-effectiveness of a simultaneous bilateral THA to that of staged unilateral procedures following the implementation of OR efficiency strategies. Between 2017 and 2019, 446 simultaneous and 238 staged bilateral primary THA patients (mean age 61.3 ± 12.0 years; 41.8% males/58.2% females; mean body mass index 27.2 ± 4.8 kg/m2) were treated by a single surgeon using an efficient, standardized workflow for efficient direct anterior approach THA on a standard operating table. There were no differences in inclusion criteria between both groups. From this cohort, 16 simultaneous bilateral THAs and 34 unilateral THAs were prospectively compared for cost-effectiveness using detailed timestamp measurements and data on personnel and material usage. Outcome was assessed based on complication and reoperation rate and patient-reported outcome measures. There was a complication rate of 1.2%, without a difference between patients who underwent a simultaneous THA vs those who underwent a staged primary THA (5/446; 1.1% vs 3/238; 1.3% P= .386). The mean OR time (patient in/out and turnover time) was 109.4 ± 19.8 minutes for bilateral THAs and 133.8 ± 12.8 minutes for 2 unilateral THAs (P < .001). An 18% time-saving and 14% cost-saving was achieved per procedure. Sharing 5% of the cost-saving with the surgeon brings benefit to both the hospital and surgeon. Implementing OR efficiency improves cost-effectiveness of simultaneous bilateral THA compared to unilateral procedures. A new value-sharing model could be a solution to align incentives.

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.

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.