The Direct Anterior Approach for 1-Stage Bilateral Total Hip Arthroplasty: Early Outcome Analysis of a Single-Surgeon Case Series

A Retrospective Analysis of the Merits and Challenges Associated with Simultaneous Bilateral THA using the Direct Anterior Approach

“…Simultaneous bilateral DAA THA resulted in significantly higher EBL compared to a single staged bilateral THA (562 vs. 337 mL) in our patients, which is similar to EBL reported above by other investigators (473-632 mL) (1, 9, 17, 18). The blood transfusion rate for simultaneous procedures we report (5/15, 33%) was similar to rates reported by Mast (1) and Lanting (17) and intermediate to rates reported by Parcells (5/22, 23%) (9) and Gondusky (62/75, 83%) (18). Furthermore, the rate of blood transfusion required in patients undergoing simultaneous bilateral DAA THA was significantly higher compared to sequential patients in both our data and the data reported by Parcells.…”

“…Significant data regarding simultaneous bilateral THA have been published but results are conflicting and different surgical approaches have been used (2–6, 8, 11, 24). To our knowledge only four previous reports have been published examining simultaneous bilateral THA performed via the DAA (1, 9, 17, 18).…”

“…Proposed advantages include a theoretical benefit of a single operative event, cost savings (1–4), shorter total postoperative hospitalisation, (2–6) and decreased time to maximal functional outcome (7). Possible disadvantages include prolonged operative duration (2, 5, 6, 8), increased estimated blood loss (EBL) and need for blood transfusion (2, 3, 5, 6, 9, 10), increased rates of venous thromboembolic events (VTE) (10, 11), higher utilisation of inpatient rehabilitation services (6, 9), increased rates of subsequent and revision hip surgeries (3), and decreased reimbursement rates (1). Published reports are inconsistent regarding these claims and include surgical approaches performed in the lateral decubitus position that require repositioning the patient, repeat prepping and draping, and exposure of the fresh surgical wound to pressure and manipulation while performing the contralateral THA.…”

“…The enhanced postoperative recovery of the DAA may help overcome the potential difficulty of rehabilitation after simultaneous bilateral hip replacements. Although numerous studies regarding simultaneous bilateral THA have been reported, there are only 4 published reports addressing the outcomes of simultaneous bilateral DAA THA, (1, 9, 17, 18) and these reports do not include current financial data that reflect the trends of costs and reimbursements in the present healthcare milieu.…”

Thirty-Day Outcomes After Bilateral Total Hip Arthroplasty in a Nationwide Cohort

“…Although a continued point of contention, there are data to suggest the anterior approach is associated with a higher infection rate [35,36]. Many same-day bilateral THAs are performed through an anterior approach [37][38][39]. The increase in early PJI seen on univariate analysis may be a result of the increased use of anterior approach in this population.…”