ONE-STAGE BILATERAL TOTAL HIP REPLACEMENT SURGERY IS SAFE AND HIGHLY COST-EFFECTIVE

Abstract

Introduction: Many patients eligible for hip arthroplasty suffer from bilateral hip disease with indication for bilateral total hip replacement (BTHR). Traditionally two-stage BTHR is far more common than one-stage procedure due to the risk of complications. However, most studies are in favour of one-stage BTHR in the healthy and young people. This study was designed to further analyse mortality, outcome, complications and cost-effectiveness after one-stage BTHR surgery.

Patients and Methods: In this prospective matched control study we examined 32 patients with BTHR hybrid surgery. The control group of 32 patients with unilateral hybrid THR was derived from Sahlgrenska University hospital. The follow up time was 1 year. Medical records, cost per patient database, records from Swedish Social Insurance Administration and HRQoL outcome measurements from the Swedish Hip Arthroplasty Register were used for the analyses.

Mortality data from the Register regarding all 950 patients with one-stage BTHR surgery during the period 1992 until 2005 were compared to those 2577 who had had a twostage procedure with less than six months between the operations.

Preliminary Results: There were no major differences in complications. The intraoperative bleeding was higher in the BTHR patients and they required more blood transfusion. Length of hospital stay was in average 10,2 days for the one-stage BTHR group and 7,6 days for the unilateral group. Preoperative EQ-5D index was 0,14 in the BTHR group and 0,31 in the control group. Mean EQ-5D gain after 1 year was 0,77 and 0,40 respectively. Hospital costs were only 60% higher in the one-stage BTHR group. Among the employed patients there were no differences in days of sick pay and cost of sick pay in the two groups. Among the 950 subjects with one-stage BTHR surgery, the 90 day mortality was 0,32% compared to 0,42% in the group of 2577 patients with two-stage procedure.

Discussion: In healthy patients with bilateral hip disease requiring bilateral arthroplasty one-stage BTHR is highly cost-effective and safe. There is even lower 90 day mortality for the onestage operated subjects in the register but this is probably due to a natural selection of younger and healthier patients. The one-stage procedure reduces the total time of rehabilitation which is of particular importance for people in working age. Cautiously estimated, performing another 100 one-stage BTHR per year instead of two-stage procedure would save 16–20 million SEK yearly in Sweden.