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

Abstract

Background: 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).

Methods: 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.

Results: The mean operative time per hip was 51.3 ± 19.4 min (range, 22-180 min) in unilateral group and 46.2 ± 15.1 min (range, 26-106 min) in simultaneous bilateral group. The mean operative blood loss per hip was 421.2 ml ± 232.1 ml (range, 70-1300 ml) in unilateral group and 200.8 ± 149.8 ml (range, 30-1040 ml) 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.

Conclusion: 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.