COMPARISON OF TWO SERIES OF BILATERAL TOTAL HIP ARTHROPLASTIES: SIMULTANEOUS VERSUS DEFERRED IMPLANTATION

Abstract

Purpose: Bilateral hip disease is a common finding. For patients in good general health the question is whether total hip arthroplasty should be performed on both sides during the same operation or whether a deferred strategy would be better. We compared 24 patients (48 hips) to determine the relative advantages of these two treatment strategies.

Material and methods: Two treatment groups were formed: the first group (group A) was a prospective series of 12 patients who underwent total hip arthroplasty for both hips during the same operation between January 1992 and September 1999; the second group (group B) was composed of 12 patients who had total hip arthroplasty for both hips implanted during two different operations separated by at least one year and chosen by random selection among patients operated during the same period as group A patients. Group A was composed of five women and seven men, mean age 48.4 years (23–67). Group B was composed of five women and seven men, mean age 60 years (50–75). Pressfit cups were used in both groups (except one in group A). The femoral stem was cemented in seven patients in group A and in five in group B. Peroperative data (transfusion, complications, anaesthesia agents, duration of anaesthesia and operation) and post-operative data (transfusions, blood loss, haemoglobin, temperature curve, hospital stay, drugs, early and late complications, radiologic findings) were studied. LWMH was given prophylactically and all patients had a duplex Doppler exploration before discharge. All patients were reviewed regularly: mean follow-up was 5.75 years (2–9) in group A and 6.42 years (2.33–8.5) in group B.

Results: We added the two hospitalisations for group B patients. Mean duration of the operation was 6h in group A and 4h22m in group B. Anaestheia lasted 7h in group A and 6h16min in group B. Blood transfusions amounted to 5.27 packed cell units and 3.09 fresh frozen plasma units in group A, 4.75 and 2.83 respectively in group B. Blood loss was 1439 cc in group A and 1642 cc in group B. Haemoglobin and temperature curves were similar between the two groups. There were two cases of postoperative phlebitis in group A and one revision procedure on day 9 for haematoma in group B. There were no cases of infection. Mean hospital stay was 14.66 days in group A and 22.5 days in group B. Radiographs did not show evidence of loosening.

Discussion: The results obtained in our two series are similar to other reports in the literature (Eggle 1996, Shih 1985). Per- and postoperative complications were not more frequent for one or two procedures. Hospitalisation stays were much shorter in group A patients, providing an important cost savings (34.8% for simultaneous implantations).

Conclusion: Bilateral total hip arthroplasty during a single operation offers an advantage in terms of hospital stay and overall cost. Comparison with two different operations shows that complications are not more frequent. Inversely, work stoppage is shorter, making this strategy particularly interesting for younger patients.