One- Versus Two-Stage Bilateral Total Hip Arthroplasty

Saito, Shu; Tokuhashi, Yasuaki; Ishii, Teruhisa; Mori, Sei; Hosaka, Kunihiro; Taniguchi, Shin

doi:10.3928/01477447-20100625-07

Cited by 34 publications

(22 citation statements)

References 24 publications

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“…In staged bilateral THA, the cumulative complications of two separate procedures could be higher. However, simultaneous bilateral THA means more blood loss and surgical time for one procedure 8,18,19 , which increases the risks. A meta-analysis 15 came out in favor of simultaneous bilateral THA because of reported lower rates of major systemic complications, but the data were highly heterogeneous, with only one study included that listed death as a major systemic complication 7 .…”

Section: Discussionmentioning

confidence: 99%

“…However, patients in the simultaneous group received more cumulative blood transfusions than patients in the staged group (median [interquartile range]: 4 [4][5][6] vs 4 [0-6.5]; P < 0.001). However, their LOS was shorter than the LOS for patients in the staged group (median [interquartile range]: 11 [8][9][10][11][12][13][14] vs 20 [16][17][18][19][20][21][22][23][24]; P < 0.001).…”

Section: Readmission Cumulative Transfusion and Length Of Staymentioning

confidence: 99%

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Retrospective Cohort Study Comparing Complications, Readmission, Transfusion, and Length of Stay of Patients Undergoing Simultaneous and Staged Bilateral Total Hip Arthroplasty

Guo

Shao

Huang

et al. 2020

Orthopaedic Surgery

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Objectives To determine whether the rates of postoperative complications, rate of readmission, cumulative transfusion volume, and length of stay (LOS) differ between simultaneous total hip arthroplasty (THA) and staged bilateral THA and to assess whether the length of the interval between staged procedures influences surgery outcome. Methods This was a retrospective cohort study comparing the rate of postoperative complications, readmission, cumulative transfusion volume, and LOS between simultaneous THA and staged bilateral THA in our hospital's registration database. The inclusion criteria is listed as follows: patients who underwent bilateral primary THA between January 2011 and January 2015 with minimum 3‐month follow‐up; simultaneous bilateral THA; staged bilateral THA; postoperative complications, readmission, cumulative transfusion volume, length of stay of the patients and the influence of the interval between stages of bilateral THA on the outcome above; and retrospective cohort study. Finally, a total of 1145 patients, including simultaneous bilateral THA in 863 patients (1726 hips) and staged bilateral THA in 282 patients (564 hips), were eligible for the present study. The patients were divided into three groups according to the interval time (≤30 days, 30–90 days, >90 days) between the two stages of bilateral THA and we compared postoperative complications, readmission rates, cumulative transfusion volume, and LOS for the three groups. All patients’ medical records and outpatient notes were reviewed to extract preoperative data, perioperative complications, readmission, cumulative transfusion, and LOS. Preoperative information included patients’ age, sex, diagnosis, body mass index, and American Society of Anesthesiologists (ASA) classification. Perioperative complications were sorted into two groups: (i) medical complications included cardiovascular, pulmonary, neurological, digestive, and urologic system complications, along with other miscellaneous issues; and (ii) surgical complications included dislocation, superficial wound infection, hematoma, deep periprosthetic joint infection, and nerve palsy. Patients who failed to come back to visit our hospital in the postoperative 3 months were followed up by telephone, at which point we inquired about any postoperative complications and readmission. Results Simultaneous THA was performed more often in younger men, and patients in the simultaneous group had fewer major medical complications (excluding venous thromboembolism), fewer surgical complications, and shorter hospital stays; however, patients in the simultaneous group were likelier to have a higher transfusion rate than patients in the staged group. Among patients in the staged group, there were no differences for differing time intervals, except that patients with a between‐stage interval of ≤30 days required more blood transfusions. Conclusion With careful patient assessment and selection, simultaneous bilateral THA is a safe procedure, and has lower rates of surgical and major medical complic...

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Section: Discussionmentioning

confidence: 99%

Section: Readmission Cumulative Transfusion and Length Of Staymentioning

confidence: 99%

Retrospective Cohort Study Comparing Complications, Readmission, Transfusion, and Length of Stay of Patients Undergoing Simultaneous and Staged Bilateral Total Hip Arthroplasty

Guo

Shao

Huang

et al. 2020

Orthopaedic Surgery

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“…This study also benefitted from being a single surgeon series thus reducing the potential variability in surgical practice seen in other studies of bilateral hip staging surgery [15]. …”

Section: Discussionmentioning

confidence: 99%

Bilateral hip arthroplasty: Is 1-week staging the optimum strategy?

Atkinson

Bailey

Willis-Owen

et al. 2010

Journal of Orthopaedic Surgery and Research

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Seventy-nine patients underwent bilateral hip arthroplasty staged either at 1 week (Group 1) or after greater intervals (as suggested by the patients, mean 44 weeks, range 16-88 weeks) (Group 2), over a five year period at one Institution. Sixty-eight patients (29 bilateral hip resurfacings and 39 total hip replacements) completed questionnaires regarding their post-operative recovery, complications and overall satisfaction with the staging of their surgery.There was no significant age or ASA grade difference between the patient groups. Complication rates in the two groups were similar and overall satisfaction rates were 84% in Group 1 (n = 32) and 89% in Group 2 (n = 36). Cumulative hospital lengths of stay were significantly longer in Group 1 patients (11.9 days vs 9.1 days)(p < 0.01); this was true for both hip resurfacing and total hip arthroplasty patients, however resurfacing patients stays were significantly shorter in both groups (p < 0.01). Postoperative pain resolved earlier in Group 1 patients at a mean of 20.9 weeks compared with a cumulative 28.9 weeks (15.8 and 13.1 weeks) for Group 2 patients (p = 0.03).The mean time to return to part-time work was 16.4 weeks for Group 1, and a cumulative 17.2 weeks (8.8 and 8.4 weeks) for Group 2. The time to return to full-time work was significantly shorter for Group 1 patients (21.0 weeks, compared with a cumulative 29.7 weeks for Group 2)(p < 0.05). The time to return to both full and part-time work was significantly shorter in total hip replacement patients with 1-week staging compared with delayed staging (22.0 vs 35.8 weeks (p = 0.02), and 13.8 vs 19.3 weeks (p = 0.03) respectively).Hip resurfacing patients in Group 2 had significantly shorter durations of postoperative pain and were able to return to part-time and full time work sooner than total hip arthroplasty patients. There was a general trend towards a faster recovery and resumption of normal activities following the second operation in Group 2 patients, compared with the first operation.Bilateral hip arthroplasty staged at a 1-week interval resulted in an earlier resolution of hip pain, and an earlier return to full-time work (particularly following total hip replacement surgery), with high levels of patient satisfaction and no increased risk in complications; however the hospital length of stay was significantly longer. The decision for the timing of staged bilateral surgery should be made in conjunction with the patient, making adjustments to accommodate their occupational needs and functional demands.

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“…Although the majority of total hip arthroplasties (THAs) being performed are unilateral, bilateral osteoarthritis of the hip develops in 42 % of patients, necessitating replacement of both hips [1]. In spite of the existing controversy regarding the safety of one-stage bilateral THA, some surgeons prefer this approach in selected patients due to its benefits, which include faster recovery, easier rehabilitation, shorter hospital stay, lower procedure cost and one-session anaesthetic risk [2,3].…”

Section: Introductionmentioning

confidence: 99%

Does the surgical approach in one stage bilateral total hip arthroplasty affect blood loss?

Parvızı

Rasouli

Jaberi

et al. 2013

International Orthopaedics (SICOT)

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Purpose It is not clear whether type of surgical approach affects the amount of blood loss in one-stage bilateral total hip arthroplasty (THA). This study therefore aims to examine if type of surgical approach can affect peri-operative blood loss and allogeneic blood transfusion in patients undergoing one-stage bilateral THA. Methods Records of 319 patients who underwent one-stage bilateral THA from January 2004 to June 2011 were retrospectively reviewed. Patients were divided into two groups: direct anterior (DA) approach (75 patients) and direct lateral (DL) approach (244 patients). Blood loss was calculated using a previously validated formula. Blood loss and need for allogeneic blood transfusion were compared between the two groups. Additionally, the effects of using cell saver and surgical approach were evaluated in a multivariate analysis. Results Compared to the DL approach, calculated blood loss was significantly lower in the DA group (2,813.90±804.13 ml vs 3,617.03±1,148.47 ml) and a significantly lower per cent of patients needed allogeneic blood transfusion in the DA group (26.6 vs 52.4 %). Intra-operative cell saver was used in 36 patients. Compared to the non-cell saver group, mean blood loss was significantly higher in the cell saver group (4,061.0± 1,285.55 ml vs 3,347.71±1,083.85 ml), whereas the difference between the two groups regarding allogeneic blood transfusion was not statistically significant. The DA approach was an independent predictor of lower peri-operative blood loss and allogeneic blood transfusion while using cell saver was not.Conclusions Our results may be explained by the lower extent of muscular dissection performed in the DA approach. Our findings also indicate that intra-operative cell salvage might not be justified in bilateral THA performed expeditiously.

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One- Versus Two-Stage Bilateral Total Hip Arthroplasty

Cited by 34 publications

References 24 publications

Retrospective Cohort Study Comparing Complications, Readmission, Transfusion, and Length of Stay of Patients Undergoing Simultaneous and Staged Bilateral Total Hip Arthroplasty

Retrospective Cohort Study Comparing Complications, Readmission, Transfusion, and Length of Stay of Patients Undergoing Simultaneous and Staged Bilateral Total Hip Arthroplasty

Bilateral hip arthroplasty: Is 1-week staging the optimum strategy?

Does the surgical approach in one stage bilateral total hip arthroplasty affect blood loss?

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