ONE- OR TWO-STAGE METAL-ON-METAL HIP RESURFACING ARTHROPLASTY.

Abstract

Introduction: Patients suitable for hip resurfacing are often young, active, in employment and have bilateral disease. One-stage bilateral total hip replacement has been demonstrated to be as safe as a two-stage procedure and more cost effective. The aim of this study was to compare the results of one-stage with two stage bilateral hip resurfacing.

Methods: Between July 1994 and August 2006 a consecutive series of 93 patients underwent bilateral hip resurfacing within a year. 34 patients in the one-stage group. 44 patients in the two-stage group. The age, gender, diagnosis, ASA grade, total operative time, blood transfusion requirements, medical and surgical complications, length of stay, revision and costs were recorded.

Results: There were no significant differences in age, gender, and ASA grade between the two groups. There were 4 minor complications in the one stage group and 5 in the two-stage group. All complications were of a short-term nature. There was no significant difference in the blood transfusion requirements. There was a significantly longer total mean hospital stay of 5 days (95% c.i. 4.0–6.9) for the two-stage group. No patients had undergone a revision. The hospital received a mean of £6338 per patient for the one-stage group and a mean of £9726 per patient for the two-stage group. However, this included a longer total hospital stay, two anaesthetics and on average two extra out-patient appointments.

Conclusions: This study demonstrates no detrimental effects when performing a one-stage bilateral hip resurfacing in comparison to a two-stage procedure. The advantages of the one-stage procedure are that total hospital stay is reduced by a mean of 5 days and the cost is reduced by a mean of £3388 per patient, a 35% reduction of the cost of a two-stage procedure. These benefits do not appear to come at the cost of increase complications.