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

Abstract

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.

Functional and Radiological Outcomes Following Simultaneous Bilateral Total Hip Arthroplasty: Analysis of a Retrospective Series

“…Our study shows good medium-term patient-reported functional outcomes following simultaneous bilateral THR at a mean follow-up of 7.8 years. Radiological assessment did not show any worse LLD when compared to standard mean values of 3-17 mm after THR described in a literature review [16], thus negating our initial hypothesis. In our series, parameters such as intra-operative blood loss, mean hospital stay, and postoperative complications, such as thromboembolic events, showed an improvement over existing studies, although this should be taken in the context of our series being low volume.…”

“…The practice of simultaneous bilateral THR was shown in earlier studies to be associated with an increase in complications such as deep vein thrombosis (DVT), prosthetic joint infection (PJI), heterotrophic ossification (HO), and decreased gait stability [9][10][11]. Recent literature has shown equivalent rates of mortality and PJI when compared to staged procedures, but increased rates of pulmonary embolism (PE) [16]. The advocates of simultaneous bilateral THR argue that it is cost-effective by reducing the overall length of hospital stay and anaesthetic and surgical time without any significant change in functional outcome as compared to a staged procedure [12][13][14].…”

Concurrent replacement of four major joints in a woman with advanced rheumatoid arthritis

“…The comparative studies of simultaneous total joint arthroplasty involving two joints (either both knees, both hips, or an ipsilateral combination of hip and knee during a single anaesthesia session) versus staged procedures performed under separate anaesthesia sessions have been extensively researched 2 5–11. Simultaneous bilateral TKA initially had higher complication rates than staged bilateral or unilateral TKA.…”

“…Similarly, simultaneous bilateral THA results in fewer complications, including reduced deep vein thrombosis and systemic, local, and pulmonary complications. Additionally, it offers cost savings due to shorter hospital stays and less blood loss compared with staged THA 11. However, it is advisable to avoid performing multiple joint replacements during a single anaesthetic session in elderly patients, those with multiple comorbidities (especially with an American Society of Anesthesiologist’s physical status classification >3), patients who are not mentally prepared for such procedures, and in healthcare centres with low surgical volumes.…”

“…However, it is advisable to avoid performing multiple joint replacements during a single anaesthetic session in elderly patients, those with multiple comorbidities (especially with an American Society of Anesthesiologist’s physical status classification >3), patients who are not mentally prepared for such procedures, and in healthcare centres with low surgical volumes. This approach helps in minimising risks and ensuring patient safety 8–11…”