A Retrospective Analysis of the Merits and Challenges Associated with Simultaneous Bilateral THA using the Direct Anterior Approach

Brown, Matthew L.; Plate, Johannes F.; Holst, David C.; Bracey, Daniel N.; Bullock, Matthew; Lang, Jason E.

doi:10.5301/hipint.5000449

Cited by 12 publications

(15 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Concomitant to our results, several studies have exhibited no difference in LLD between simBTHA and stgBTHA [ 36 , 37 , 40 ]. However, LLD can yield patient dissatisfaction after THA [ 82 ].…”

Section: Discussionsupporting

confidence: 88%

See 1 more Smart Citation

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

et al. 2022

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionsupporting

confidence: 88%

“…Functional recovery was faster in simBTHA, as walking without support started earlier [ 36 ] and walking capacity was better postoperatively [ 21 , 28 ]. Rates of home-discharged patients for stgBTHA were higher in all studies [ 25 , 26 , 40 , 41 , 43 , 49 , 54 ].…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2022

View full text Add to dashboard Cite

show abstract

“…The application of the DAA in one-stage bilateral THA was rarely reported. Brown et al [ 15 ] suggested that the DAA could be safely and effectively applied in one-stage bilateral THA without resulting in increased complications compared to sequential hip arthroplasty if perioperative pain and blood loss could be properly managed. In a retrospective review covering 325 consecutive cases, Tamaki et al [ 16 ] concluded that, due to supine position and the minimally invasive nature of the DAA, the rate of systemic complications such as dislocation was lower with one-stage bilateral THA.…”

Section: Discussionmentioning

confidence: 99%

The direct anterior approach for simultaneous bilateral total hip arthroplasty: a short-term efficacy analysis

et al. 2020

View full text Add to dashboard Cite

Purpose Compared to the posterior approach (PA), the direct anterior approach (DAA) can achieve better clinical outcomes for total hip arthroplasty (THA). The purpose of this study was to investigate whether the same advantages associated with the DAA could be attained in patients undergoing simultaneous bilateral THA. Method We retrospectively reviewed 89 patients who underwent one-stage bilateral THA through the DAA (group A, n = 46) and through the PA (group B, n = 43) between June 2015 and November 2017 at our institution. The patients were followed up for a minimum of 1 year. There were no significant differences in gender, age, body mass index (BMI), preoperative hemoglobin level, preoperative Harris hip score (HHS), and preoperative visual analogue scale (VAS) score between the two groups (P > 0.05 for all). Results The incision length, operation time, intraoperative blood loss, blood transfusion volume, and the length of stay (LOS) were significantly less in group A than in group B (p < 0.05). The surgery-related complications were not significantly lower in group A (5.43%) than in group B (10.47%) (χ2 = 2.209, p = 0.112). In 46 cases in group A, one hip had an acetabular anteversion higher than normal value. In both groups, one hip developed aseptic loosening. The HHS was significantly higher in group A than in group B 1, 3, 12 month(s) after operation (p < 0.05). The VAS was significantly lower in group A than in group B 1, 3, 12 month(s) after operation. Against the simple Likert scale, comprehensive satisfaction was significantly higher in group A (97.8%, 45/46) than in group B (76.7%, 33/43) (χ2 = 9.119, p = 0.003). Conclusion In patients who underwent simultaneous bilateral THA, DAA could significantly relieve pain, accelerate the functional recovery of hip joint and improve the satisfaction more than PA. In clinical practice, however, more attention should be paid to strict compliance to operative indications and the prevention of early complications. The long-term effectiveness warrants further observation.

show abstract

“…Levels of evidence were determined with the Oxford Centre for Evidence-based Medicine Levels of Evidence tool (2011) ( 26 ). A consensus was reached between both authors through discussion.…”

Section: Methodsmentioning

confidence: 99%

A systematic review comparing the cost-effectiveness of the direct anterior, posterior, and straight lateral approach in total hip arthroplasty

Geilen,

Hermans,

Droeghaag

et al. 2023

EFORT Open Reviews

View full text Add to dashboard Cite

Background Total hip arthroplasty is a reliable option to treat osteoarthritis. It reduces pain, increases quality of life, and restores function. The direct anterior approach (DAA), posterior approach (PA), and straight lateral approach (SLA) are mostly used. This systematic review evaluates current literature about costs and cost-effectiveness of DAA, PA, and SLA. Methods A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) systematic search, registered in the PROSPERO database (registration number: CRD42021237427), was conducted of databases PubMed, CINAHL, EMBASE, Cochrane, Clinical Trials, Current Controlled Trials, ClinicalTrials.gov, NHS Centre for Review and Dissemination, Econlit, and Web of Science. Eligible studies were randomized controlled trials (RCTs) or comparative cohort studies reporting or comparing costs or cost-effectiveness of either approach as the primary outcome. The risk of bias (RoB) was assessed. For comparison, all costs were converted to American Dollars (reference year 2016). Results Six systematic review studies were included. RoB ranged from low to high, the level of evidence ranged from 2 to 4, and methodological quality was moderate. Costs ranged from $5313.85 to $15 859.00 (direct) and $1921.00 to $6364.30 (indirect) in DAA. From $5158.46 to $12 344.47 (direct) to $2265.70 to $5566.01 (indirect) for PA and from $3265.62 to $8501.81 (direct) and $2280.16 (indirect) for SLA. Due to heterogeneity of included costs, they were not directly comparable. Solid data about cost-effectiveness cannot be presented. Conclusions Due to limited and heterogenous evidence about costs and cost-effectiveness, the effect of these in surgical approach is unknown. Further well-powered research to make undisputed conclusions is needed.

show abstract

A Retrospective Analysis of the Merits and Challenges Associated with Simultaneous Bilateral THA using the Direct Anterior Approach

Abstract: While simultaneous DAA THA presents challenges, our results suggest that simultaneous DAA THA may add value to the healthcare system without resulting in increased complications compared to sequential hip arthroplasty.

Cited by 12 publications

References 31 publications

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

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

The direct anterior approach for simultaneous bilateral total hip arthroplasty: a short-term efficacy analysis

A systematic review comparing the cost-effectiveness of the direct anterior, posterior, and straight lateral approach in total hip arthroplasty

Contact Info

Product

Resources

About