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Meta-Analysis
. 2022 Aug 13;17(1):392.
doi: 10.1186/s13018-022-03281-4.

Simultaneous versus staged bilateral total hip arthroplasty: a systematic review and meta-analysis

Akam Ramezani  1 , Amirhossein Ghaseminejad Raeini  1 , Amirmohammad Sharafi  1 , Mehrdad Sheikhvatan  1   2 , Seyed Mohammad Javad Mortazavi  3 , Seyyed Hossein Shafiei  4
Affiliations
Meta-Analysis

Simultaneous versus staged bilateral total hip arthroplasty: a systematic review and meta-analysis

Akam Ramezani et al. J Orthop Surg Res. .

Abstract

Background: Total hip arthroplasty is a common orthopedic surgery for treating primary or secondary hip osteoarthritis. Bilateral total hip replacement could be performed in a single stage or two separate stages. Each surgical procedure's reliability, safety, and complications have been reported controversially. This study aimed to review the current evidence regarding the outcomes of simultaneous and staged bilateral total hip arthroplasty.

Methods: We conducted a meta-analysis using MEDLINE, EMBASE, Web of Science, and Scopus databases. Eligible studies compared complications and related outcomes between simultaneous and staged bilateral THA. Two reviewers independently screened initial search results, assessed methodological quality, and extracted data. We used the Mantel-Haenszel method to perform the meta-analysis.

Results: In our study, we included 29,551 patients undergoing simBTHA and 74,600 patients undergoing stgBTHA. In favor of the simBTHA, a significant reduction in deep vein thrombosis (DVT) and systemic, local, and pulmonary complications was documented. However, we evidenced an increased pulmonary embolism (PE) and periprosthetic fracture risk in simBTHA. In the simBTHA, total blood loss, length of hospital stay, and total cost were lower.

Conclusion: This meta-analysis shows that simultaneous bilateral THA accompanies fewer complications and lower total cost. Well-designed randomized controlled trials are needed to provide robust evidence.

Keywords: Bilateral total hip replacement; Complications; Cost–benefit analysis; Functional outcomes; Meta-analysis; Total hip arthroplasty.

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Conflict of interest statement

The authors have no relevant financial or non-financial interests to disclose.

Figures

Fig. 1
Fig. 1
PRISMA flowchart showing identification, screening, and inclusion of studies for review
Fig. 2
Fig. 2
Forest plot of a DVT, b PE, and c pulmonary complications. M-H, Mantel–Haenszel; OR, odds ratio; 95% CI, 95% confidence interval
Fig. 3
Fig. 3
Forest plot of a systemic complications and b local complications. M-H, Mantel–Haenszel; OR, odds ratio; 95% CI, 95% confidence interval
Fig. 4
Fig. 4
Forest plot of a periprosthetic joint infection, b periprosthetic fracture, and c dislocation. M-H, Mantel–Haenszel; OR, odds ratio; 95% CI, 95% confidence interval
Fig. 5
Fig. 5
Forest plot of 90-day mortality. M-H, Mantel–Haenszel; OR, odds ratio; 95% CI, 95% confidence interval
Fig. 6
Fig. 6
Forest plot of LOS. MD, mean difference; 95% CI, 95% confidence interval
Fig. 7
Fig. 7
Forest plot of a total blood loss, b blood transfusion need, and c total cost. MD, mean difference; 95% CI, 95% confidence interval
Fig. 8
Fig. 8
Forest plot of a postoperative HHS and b postoperative LLD. MD, mean difference; 95% CI, 95% confidence interval
Fig. 9
Fig. 9
Forest plot of a revision and b readmission. MD, mean difference; 95% CI, 95% confidence interval
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