Surgical accuracy, function, and quality of life of simultaneous versus staged bilateral Total hip Arthroplasty in patients with Osteonecrosis of the femoral head

Abstract

BackgroundThe optimal surgical option for patients requiring bilateral hip replacement remains controversial. The purpose of this study was to compare surgical accuracy; functional outcome and health-related quality of life; and prosthetic-related complications and revision surgery of a simultaneous bilateral total hip arthroplasty (THA) with those of a staged bilateral THA with an interval between procedures <12 months.MethodsA total of 123 unselected consecutive patients (mean age, 43.3 years) who underwent bilateral THAs for osteonecrosis of the femoral head (ONFH) with a minimum follow-up of two years (mean, 60.2 months) were studied retrospectively; 63 simultaneous procedures served as a test group and 60 staged procedures served as a control group.ResultsThe mean postoperative leg-length discrepancy (LLD) and the percentage of patients who had an LLD >3 mm were significantly lower in the simultaneous group (P < 0.001 and P = 0.001, respectively). A higher number of cups within the safe zones, a higher correction rate, and a lower failure rate for the cup placement in the second-operated hip were also identified in the simultaneous group. The mean Harris hip score, EuroQol-5D index, and EuroQol-visual analogue scale score were all better in the simultaneous group at the latest follow-up (P < 0.001, in all comparisons). We found that the simultaneous procedure was associated with a lower incidence of postoperative prosthetic-related complications and revision surgery.ConclusionsWe suggest that bilateral ONFH could be treated with a simultaneous THA rather than a staged THA to achieve a better surgical outcome.

Stromal-Cell-Derived Factor (SDF) 1-Alpha Overexpression Promotes Bone Regeneration by Osteogenesis and Angiogenesis in Osteonecrosis of the Femoral Head

“…Osteonecrosis of the femoral head (ONFH) is a devastating disease, which is characterized by cellular demise within the femoral head [1], progressive deterioration of the hip joint [2], and severely lowered quality of life [3, 4]. Although corticosteroid usage [5], alcohol consumption [6, 7], and trauma [8] have been identified as risk factors for ONFH, its pathogenesis remains poorly understood.…”

Costs analysis of Staged Versus Simultaneous Bilateral Total Knee and Hip Arthroplasty: a university affiliated hospital survey of 1579 Chinese patients

“…Despite bilateral knee and hip arthroplasty being frequently performed, most studies paid attention to clinic outcomes, and only a few studies have been published recently on this topic. However, previous studies have not compared costs about THA, to say nothing of comparing costs when pooled both THA and TKA patients [2,7,12]. In this study, we compared the cost of simultaneous and staged procedures among TKA, THA, and their combination groups, found a signi cant difference between the two procedures in three groups.…”

“…Kamath et al [1] did not nd signi cant differences for complications between the simultaneous THA group and the staged THA group either. Seung-Chan Kim et al [12] found a lower incidence of postoperative prosthetic-related complications in the simultaneous THA group. When it turns to TKA, several studies reported a lower rate of complications in the simultaneous TKA group [14,16,19,24,25].…”

“…These are two different strategy of surgical procedures. However, there exists debate regarding performing staged bilateral TKA or THA with an interval between procedures or simultaneous bilateral TKA or THA patients, primarily because of the controversy about the outcomes of two procedures [7,12]. The comparison between the two types of surgery is not consistent.…”

“…Previous studies about simultaneous bilateral TKA versus staged TKA and simultaneous THA vs. staged THA have made some progress. But their research focuses always concentrated on clinical outcomes, such as operative and anesthetic times, EuroQol-5D index, health-related quality of life, blood loss, Harris hip score, and in-hospital mortality rates [1,[12][13][14][15]. Whereas to the best of our knowledge, no recent study has presented a direct comparison of actual hospital costs for both TKA and THA.…”