Simultaneous bilateral minimally invasive total hip arthroplasty: A comprehensive review of the literature

Abstract

Several studies have reported that minimally- invasive total hip arthroplasty (MISTHA) may significantly reduce postoperative pain and results in faster postoperative rehabilitation when compared with the traditional lateral or posterior approach. Regarding bilateral hip osteoarthritis, there is still no consensus whether simultaneous bilateral MIS-THA can be established as the treatment of choice. Therefore, we searched the international databases of Pubmed, Medline, and Cochrane Database of Systematic Reviews using the key words minimally invasive bilateral total hip arthroplasty. From the initial 23 articles we found five clinical studies which met our inclusion criteria. From the perspective of possible intra- and postoperative complications, one-stage bilateral MIS THA was equally safe or safer than two-stage interventions. In addition, from a clinical outcome perspective, the one-stage procedure can be considered to be preferable. Higher blood transfusion requirements, which were expected following the standard bilateral simultaneous THA, seemed to be minimized with the simultaneous bilateral MIS THA. The supine position of the patient minimized the mean operation time. Approaches using the lateral decubitus position of the patient should be avoided in simultaneous bilateral THA due to the increased operation time. There is a lack of randomized, controlled clinical trials, comparing simultaneous bilateral MIS THA with staged bilateral MIS THA. Although simultaneous bilateral MIS THA seems to be efficacious, cost-effective and safe, more clinical trials are required to establish its superiority over the sequential MIS THA.

One-stage vs two-stage bilateral THA in Lombardy: a cost-effectiveness analysis

“…Moreover, it must be considered that, despite the more extensive surgical exposure of 1-BTHA given the bilateral incision the mean blood loss was still acceptable. Additionally, our cost analysis showed that 1-BTHA, rather than 2-BTHA, could be advantageous in term of cost-effectiveness when performed in selected patients, as stated by other authors [ 3 , 6 , 14 ]. Considering the shorter total OR time and LOS, performing 1-BTHA could lead to an improvement in OR availability and decrease in wait list time [ 17 ].…”

“…1-BTHA could provide fewer cardiopulmonary complications, incidence of deep venous thrombosis (DVT), and no significant difference in blood loss, likely to be related to the shorter anesthesia and surgical time [ 1 , 15 ]. Furthermore, 1-BTHA provides a single hospitalization, risks associated with only one anesthetic, a shorter rehabilitation time and a higher patient satisfaction [ 6 ]. For instance, Taheriazam et al stated that 1-BTHA can be employed without any increase in complication rate, showing clinical and functional outcomes comparable to 2-BTHA and a substantially shorter LOS [ 3 ].…”

“…Several clinical conditions can influence the development of secondary hip OA, such as avascular necrosis, rheumatoid arthritis, ankylosing spondylitis, and congenital dysplasia [ 1 , 5 ]. It has been observed that almost 20% of all patients who underwent primary THA suffer from bilateral hip OA and, consequently, will need a contralateral procedure to be performed in the following years [ 3 , 6 ]. Moreover, several studies have suggested the safety and reliability of one-stage bilateral THA (1-BTHA) in low-risk patients [ 7 ], showing a reduction of the length of stay (LOS), a shorter anesthesia and surgery time, a faster rehabilitation and a better cost-effectiveness [ 7 , 8 ].…”

Is simultaneous bilateral total hip arthroplasty deleterious in a biomechanical point of view? A comparative gait analysis study

“…In conclusion, SBTHA is known to be the safest and cost saving procedure in a population with symptomatic bilateral HO that improves QOL as proven with PROM’s according to ICHOM standards [ 33 , 34 ]. We may now attest, based on a walking laboratory analysis at 6 months post operatively, in a DAA without traction table cohort study, that SBTHA produces a similar gait pattern, an optimal recovery, and a non-excessive energetic cost compared to UTHA in unilateral HO.…”

Direct Anterior Approach for Total Hip Arthroplasty in the Lateral Decubitus Position Versus Supine Position: A Random Clinical Trial

“…The supine position is the position in which most surgeons begin to learn DAA, and it is also described in most studies, especially in the posterolateral position. Malahias et al believe that simultaneous bilateral THA at the same time is effective and safe [15]. In order to reduce the operation time, lateral position should be avoided when the patient requires bilateral surgery.…”