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

Abstract

Background: Approximately 42% of patients with end-stage osteoarthritis have bilateral disease. Although bilateral total hip arthroplasty (THA) is physiologically demanding, certain patients may benefit from simultaneous rather than staged bilateral procedures. This study examines the intraoperative differences and 30-day outcomes in patients receiving bilateral THA compared with those who underwent unilateral THA. Methods: Patients undergoing THA were selected from the National Surgical Quality Improvement Program database from 2008 to 2015. Patients were selected according to those with primary and concurrent coding for Current Procedural Terminology 27130. Thirty-day complications were recorded, and multivariate analyses were performed to determine whether concurrent THA was a risk factor for poor outcomes. Results: A total of 97,804 patients and 587 patients who underwent unilateral and bilateral THA, respectively, were identified. Patients who underwent bilateral procedures were younger (57.3 vs 64.6 years, P < .001), were of lower body mass index (29.2 vs 30.2, P < .001), and had fewer comorbidities than patients who underwent unilateral procedures. Length of stay was not increased for bilateral recipients (3.13 vs 2.93 days, P ¼ .308), although fewer were discharged to home (62.8% vs 77.6%, P < .001). The bilateral recipients required postoperative transfusions at a higher rate (29.8% vs 10.9%, P < .001) and had an increased incidence of deep wound infections on univariate analysis (1.2% vs 0.3%, P ¼ .002). There was no increased risk of superficial infection, medical complications, or thromboembolic events for the bilateral cohort. Conclusions: Although bilateral THA recipients are younger with fewer preoperative comorbidities, bilateral THA is associated with an increased rate of transfusion in a nationwide setting. With this knowledge, specific interventions should be instituted to target these procedure-specific risks.

Bilateral simultaneous hip and knee replacement: an epidemiological nationwide study from 2001 to 2016

“…Results showed an average age under 60 years for THA and under 70 years for TKA. Taking into account the physiologic demands of patients undergoing simultaneous bilateral arthroplasty, previous studies have pointed out that they are generally younger, have lower BMI and less comorbidities than patients undergoing unilateral or staged bilateral arthroplasty [23][24][25][26]. Our results showed that the overall male/female ratio was almost equal for THA over the study period.…”

Unilateral versus simultaneous bilateral total hip arthroplasty. The Belgian experience

“…Patients who had SBTHA were younger and had less comorbidities than those who had UTHA. However, despite this difference in the groups, transfusion and deep infection rates were significantly higher for SBTHA 19 .…”

“…In 2020 Morton et al compared SBTHA and UTHA 19 . Patients who had SBTHA were younger and had less comorbidities than those who had UTHA.…”

Bilateral simultaneous hip arthroplasty shows comparable early outcome and complication rate as staged bilateral hip arthroplasty for patients scored ASA 1-3 if performed by a high-volume surgeon

“…However, other authors found no significant differences concerning thromboembolic events, cardiovascular complications, blood loss or transfusion rate [ 2 , 11 , 12 ]. Unfortunately, most of the studies only included patients with American Society of Anesthesiologists (ASA) scores of I or II [ 13 – 17 ] or lacked any evaluation of early or mid-term functional outcomes [ 1 , 2 , 8 , 14 , 18 ].…”