Abstract
Purpose: The aim of this study was to evaluate quality-of-life (QoL) in patients undergoing bilateral hip arthroplasty implanted during the same operation.
Material and methods: Sixty-one patients (28 women and 33 men) underwent surgery between November 1989 and February 2002. Average age was 42±14 years (13–76). Indications were primary osteoarthritis (n=24), secondary osteoarthritis (n=31), aseptic osteonecrosis (n=25) and rheumatoid disease (n=6). The implants (Ceraver Osteal) were cemented (50 stems, 11 cups) or coated with hydroxyapatite (72 stems, 11 cups). An alumina-alumina bearing was used in all cases. The Postel-Merle-d’Aubigné score was noted to assess function. QoL was measured prospectively in 27 patients using the SF-36 and the WOMAC, preoperatively and every three months.
Results: None of the patients were lost to follow-up. Complications included two intraoperative femoral fractures treated by cerclage, one early dislocation, three thromboemoblic events (including one case of pulmonary embolism). Unipolar revision was required for one hip due to aseptic acetabular loosening at 6.5 years. Surgical cleansing was performed in one other hip for infection. Intraoperative blood loss was 1529±451 ml (540–2550). Mean hospital stay was 13±2.5 days (8–22). At mean follow-up of 49±33 months (12–162), the mean function score was 17.8±0.5 (16–18) versus 10±2.7 (3–14) preoperatively (p< 0.05). Clinical outcome was good or excellent in 98% of the hips. There were no radiological signs of wear. A complete lucent line developed around one cup. The quality of life scores improved significantly (p< 0.01) as soon as three months postoperatively for the items ‘social activity’, ‘physical activity’ and ‘pain’, particularly in men p< 0.05).
Discussion: Bilateral hip arthroplasty during the same operative time is not advocated by all authors. It is a difficult surgical situation requiring rigor and skill. The drawbacks include longer operative time, greater blood loss, and in some patients, higher morbidity. This approach however enables treating bilateral disease in one operation, particularly in younger subjects. Use of an alumina-alumina bearing and non-cemented implants is particularly indicated. The results of this series validate the efficacy of this technique which allows rapid improvement in the patients’ quality-of-life.
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