Comparison of Per-Operative Outcomes between Simultaneous and Staged Bilateral Total Hip Arthroplasties

Abstract

Introduction: Total hip arthroplasty (THA) is an effective orthopedic surgery. Patients who go through the surgery experience better functioning and overall satisfaction with their lives. Other medical ailments like rheumatoid arthritis, ankylosing spondylitis, developmental dysplasia, and avascular femoral head necrosis require both hips to undergo THA. Retrospective studies suggest simultaneous bilateral THA (sim-BTHA) utilizes fewer hospital resources, brings about a shorter length of stay, as well as fewer complications compared to traditional methods, but does seem to have a higher requirement for blood transfusions. Despite the improvements to this procedure, comprehensive comparisons regarding single-institute approaches are sparse, creating an area of need focused on analysing complications, transfusion rates, and overall hospital length stays.

Aims and objectives: This study works to evaluate both sim-BTHA and staged bilateral THA (staged-BTHA) with particular concentration on: (1) The variations in complication rates postoperatively, (2) The variations in blood transfusion amounts required postoperatively, (3) The duration of hospital stay in proportional to the surgery.

Materials and methods: This study is a prospective cohort study that runs from January 2016 to June 2024 with a target sample size of 89 patients (44 sim-BTHA, 45 staged-BTHA). Patients were divided on the basis of age, gender, diagnosis, and other clinical parameters like ASA grade, comorbidities, hemoglobin, and bone stock, with lower-age, healthier patients in sim-BTHA group. All groups underwent a standard posterolateral approach as well as uniform perioperative protocols. Details including complications, transfusions, and length of stay were retrieved from the medical records and post-operative follow-up period of 3 months.

Results: Rates of complications were similar (36.3% sim-BTHA vs. 60% staged-BTHA, P = 0.588). Sim-BTHA was associated with lower medical complications (Gastrointestinal: 9.1% vs. 15.6%). Compared surgical complications were similar; however, deep infections and hematomas occurred only in staged-BTHA (2.2% each). Higher transfusions were seen in sim-BTHA (36.3% vs. 20%, P = 0.086). There was a significant difference in hospital stays with sim-BTHA having shorter stays than staged BTHA (14.4 vs. 28.8 days, P < 0.001). Patients with Sim-BTHA were younger (P < 0.001), had a lesser ASA score (ASA grade 1: 65.9% vs. 40%, P = 0.003), and more diagnosed cases of ankylosing spondylitis (P = 0.002).

Conclusion: For younger and fitter patients, Sim-BTHA appears to be safe, with greater complications seen in staged BTHA, increased transfusion needs, and shorter hospital stays. This supports increased usage in ideal candidates.

Keywords: Simultaneous bilateral total hip arthroplasty; bilateral total hip arthroplasty; hip replacement; staged bilateral total hip arthroplasty.

Figure 1

Bar diagram showing ASA grade comparison between two groups.

Figure 2

Bar diagram showing complication comparison between two groups.

Figure 3

Bar diagram showing hospital stay comparison between two groups.

Figure 4

Bar diagram showing blood transfusion comparison between two groups.