This study compared the morbidity, mortality, and outcomes of 900 simultaneous bilateral total hip arthroplasties in 450 patients and 450 unilateral total hip arthroplasties. Pulmonary complications were significantly higher in the simultaneous bilateral group (1.6% vs 0.7%; P < .0312). Fourteen (3.1%) patients in the simultaneous bilateral group and 18 (4%) patients in the unilateral group died within the first postoperative year. Patients with mortality in the first postoperative year were significantly older (69.8 vs 62.3 years; P < .0012). Long-term patient survival, the prosthetic survival, and functional outcomes were not significantly different between groups. Simultaneous bilateral total hip arthroplasty has advantages where both hips are symptomatic and has less risk in younger patients with understanding of the increased risk of pulmonary complications.

Simultaneous bilateral versus unilateral total hip arthroplasty an outcomes analysis.

It is believed that patients undergoing 1-stage bilateral joint arthroplasty are at higher risk for developing cardiopulmonary and possibly other complications. The aim of this prospective matched study was to evaluate and compare the morbidity profile of patients undergoing 1-stage bilateral uncemented total hip arthroplasty (BTHA) vs unilateral uncemented THA (UTHA). One hundred consecutive patients undergoing 1-stage bilateral THA (50 patients, 100 hips) and unilateral THA (50 patients) were recruited and prospectively followed. There were no statistically significant differences in 90-day mortality, individual major (BTHA, 8%; UTHA, 10%) or minor (BTHA, 20%; UTHA, 26%) complications between the 2 groups. Bilateral THA patients required more autologous and allogenic blood transfusion and had lower hemoglobin at discharge than UTHA patients. Patients undergoing BTHA should expect a slightly higher incidence of complications related to postoperative anemia.

One-stage bilateral total hip arthroplasty compared with unilateral total hip arthroplasty: a prospective study.

We compared the safety and outcome of one-stage bilateral total hip arthroplasty with those of a two-stage procedure during different admissions in a prospective, randomised controlled trial in an Asian population. Of 168 patients included in the study, 83 had a single- and 85 a two-stage procedure. Most of the patients (59.9%) suffered from inflammatory arthritis. The intra-operative complications, early systemic complications, the operating time, positioning of the components, the functional score, restoration of limb length and survival rates at 96 months were similar in the two groups. The total estimated blood loss was significantly lower in patients undergoing a one-stage procedure than in patients who had a two-stage procedure, but the transfusion requirements were significantly higher in the former group (p=0.001). The hospital stay was significantly shorter in the one-stage group, 7.25 days (sd 1.30; 5 to 20) compared with 10 days (sd 1.65; 8 to 24) in the two-stage group (p=0.023). We believe that a one-stage procedure is safe and appropriate in our population.

One- or two-stage bilateral total hip arthroplasty: a prospective, randomised, controlled study in an Asian population.

The number of single-stage bilateral total hip arthroplasties done each year is increasing. The risk of postoperative complications in medically stable patients is acceptable; complications are approximately 1.3 times more frequent than with unilateral total hip arthroplasty. Although there are no absolute indications for a single-stage bilateral total hip arthroplasty, the procedure is usually contraindicated in patients with such comorbidities as heart disease, pulmonary insufficiency, or diabetes, and it is absolutely contraindicated in patients with a documented patent ductus arteriosus or septal defect. The primary postoperative concern is that the cardiopulmonary insult associated with two surgical wounds and surgeries can lead to an increase in thromboembolic events. The cost for single-stage bilateral total arthroplasty is less than that for a two-stage bilateral total hip arthroplasty, with savings predominantly due to reduced length of acute hospital stay. However, the decision to undergo single-stage bilateral total hip arthroplasty is one that must be made in concert with the patient.

Single-stage bilateral total hip arthroplasty.

We compared the outcomes of bilateral total hip arthroplasty performed as a one-stage or two-stage procedure We retrospectively identified 196 patients (392 hips) with bilateral arthritis of the hip who underwent total hip arthroplasties: 98 patients (196 hips) as a one-stage procedure (one-stage group) and 98 (196 hips) as a two-stage procedure (two-stage group) All patients had uncemented components implanted under spinal anesthesia and had the same postoperative rehabilitation protocol Both groups' functional outcomes were similar The mean preoperative hemoglobin was 126 g/dL in the one-stage group and 129 g/dL in the two-stage group The mean cumulative blood transfusion was 26 units in the one-stage group and 35 units in the two-stage group Patients in the two-stage group had more complications, most commonly anemia and wound drainage The total mean hospital stay was longer in the two-stage group (81 days; range, 5-39 days) compared with the one-stage group (43 days; range, 3-11 days) The mean total expenses were higher in the two-stage group (dollar 64,600) compared with the one-stage group (dollar 45,900) Young and healthy patients may be candidates for one-stage bilateral total hip arthroplasty without an increase in complications and with lower costs

Bilateral total hip arthroplasty: one-stage versus two-stage procedures.

It is not clear whether bilateral hip replacement should be done in 1 or 2 stages. The total number of total hip replacements (THRs) done in our center between 1989 and 1995 was approximately 4,000. The number of hips that were bilateral was 404, or 9% of the total number of THRs performed during this time period. Of these bilateral hip replacements, 190 (95 patients) were done as a 1-stage procedure, whereas 214 (107 patients) were done in 2 stages with 2 to 24 months in between the operations. In contrast to previous studies, there were no significant preoperative differences between the 2 groups of patients having 1-stage or 2-stage THRs, and, in particular, the comorbidity assessed by the American Society of Anesthesiologists (ASA) grade was not significantly different. Our results demonstrate that, in our patient population, bilateral THR was equally safe whether performed as a 1-stage or 2-stage procedure. This was the case in the low-risk (ASA 1 and 2) and high-risk (ASA 3 and 4) patient subgroups. One-stage bilateral THR is cheaper and involves less time in the hospital.

J.A. Rech

Papers

One- or two-stage bilateral total hip replacement.