Bilateral Character of Total Hip Replacement Does Not Change the Overall Survival

Abstract

The purpose of this study was to compare the long-term survivorship of total hip replacement in unilaterally and bilaterally operated patients and try to answer the question whether analyses of combined unilateral and bilateral cases could result in erroneous interpretations. The material consisted of 266 Charnley's low-friction arthroplasties performed on 193 patients with osteoarthritis of the hip, followed for a minimum of 15 years. The 25-year survivorship of unilaterally operated hips was 69.2% (95% CI 57%-81.4%) and of bilaterally 66.4% (95% CI 57.6%-75.2%), respectively (p = 0.324). Cox regression analysis of unilateral and bilateral cases for confounding factors of gender, age and primary diagnosis confirmed that there was no significant relationship between survival of THR and whether the patient is unilaterally or bilaterally operated. Only age had a significant relationship with the survival of THR. In bilateral cases, Cox analysis for possible predictive factors found that the primary diagnosis, time interval between the two operations and sequence of the operation were not significantly correlated with the survivorship of bilateral THRs. We thus concluded that in analysing a combination of unilateral and bilateral cases, and presenting the long-term THR results, the bilateral character does not change the overall survival.

Assessment of material loss of retrieved magnetically controlled implants for limb lengthening

“…However, previous work on hip implants have shown no significant difference in survivorship between unilateral and bilateral implants. [34][35][36] This study has contributed to the work on retrieval analysis of IM implants by showing that employing metrological methods commonly used for the analysis of hip implants can offer insight into the extent of surface damage and wear sustained on the telescopic component of PRECICE nails. We suggest that further work be done to improve the protocol developed in this study to better understand the mechanism of damage.…”

Bilateral Hip Arthroplasty: When Is It Safe to Operate the Second Hip? A Systematic Review

“…To date, clinical studies have focused on finding differences between simultaneous or staged surgery, in most cases affected by selection bias, differences in confounders between populations, the lack of standardization of outcomes, and ignoring the fact that it is inappropriate to group staged surgeries without subgroups analysis considering the time lapse between procedures. Therefore, the vast majority of published studies are not homogeneous with regard to the age and comorbidities between the groups [ 7 , 10 , 20 , 22 , 30 ] or the time elapsed between procedures in the staged surgery groups [ 7 , 10 , 19 , 21 , 23 , 31 , 32 ], reflecting a clear selection bias as younger and healthier patients are more frequently allocated to simultaneous surgery, which threatens internal validity of studies, and heterogeneous basal risks, which threatens the external validity of studies. Our group had stated these limitations of available evidence in a short communication before [ 14 ].…”

Implant failure in bilateral metal-on-metal hip resurfacing arthroplasties: a clinical and pathological study

“…In fact, implant survival was slightly higher in bilateral compared with unilateral MoMHRAs, including cases that had bilateral MoMHRAs where only one implant had been revised for pseudotumour. Implant survival has not been shown to be significantly different in bilateral hip replacements using other forms of articulation such as MoP [ 8 – 10 ]. The absence of a difference in implant survival between unilateral and bilateral MoMHRAs, coupled with our histological findings that there is no significant difference in the innate and adaptive immune response between unilateral and bilateral MoMHRAs, suggests that higher metal ion levels and prior sensitization to metal wear components in bilateral MoMHRAs does not appear to significantly influence pseudotumour formation.…”

“…Groups 2 and 3 were derived from a recent single-centre prospective cohort study of 1429 MoMHRAs (1216 patients, 40% female) implanted between 1999 and 2009 [ 10 ], All cases had radiological evidence of a pseudotumour on the basis of MRI, CT or ultrasound investigations. None of the cases in Groups 1, 2 or 3 was revised for infection and in all cases the index operation was carried out for primary osteoarthritis.…”

“…Bilateral hip joint arthroplasty, carried out as a one-stage, or more commonly as a two-stage procedure, is sometimes undertaken for patients who suffer from bilateral arthritic conditions. A number of studies have shown that in bilateral metal on polyethylene (MoP) arthroplasties carried out for osteoarthritis and other arthritic conditions, outcomes are similar to unilateral MoP arthroplasties in terms of implant survival and other complications [ 8 – 10 ]. Hip MoM implants, including MoMHRAs, have also been used to treat bilateral hip arthritis [ 11 – 14 ].…”