Abstract
Background
Fifteen to twenty percent of patients presenting for total hip arthroplasty (THA) have bilateral disease. While simultaneous bilateral THA is of interest to patients and surgeons, debate persists regarding its merits. The majority of previous reports on simultaneous bilateral THA involve patients in the lateral decubitus position, which require repositioning, prepping and draping, and exposure of a fresh wound to pressure and manipulation for the contralateral THA. The purpose of this study was to compare complications, component position, and financial parameters for simultaneous versus staged bilateral THAs using the direct anterior approach (DAA).
Methods
Medical records were reviewed for patient demographics, medical history, operative time, estimated blood loss (EBL), change in hemoglobin, transfusion, tranexamic acid (TXA) use, length of stay (LOS), discharge disposition, leg length discrepancy, acetabular cup position, and perioperative complications. Cost and reimbursement data were analyzed.
Results
Forty-four patients were included in the sequential group and fifteen patients in the simultaneous group (Figure 1). Operative time was significantly longer for simultaneous DAA THA, with procedures lasting 260 +/− 48 minutes compared to 132 +/− 30 minutes for a single arthroplasty in the sequential group (p<0.001). Patients undergoing simultaneous bilateral DAA THA also had a significantly higher EBL (p<0.001), hemoglobin drop (p<0.001), and blood transfusion rate (p<0.01) compared to parameters for a single arthroplasty in the sequential group. This was despite TXA being used in a significantly higher proportion of simultaneous procedures compared to sequential procedures (p<0.01). The LOS was significantly longer in patients undergoing simultaneous bilateral DAA THA (2.9 +/− 1.0 days) compared to sequential (2.2 +/− 0.6 days) (p<0.001). No deep venous thrombosis (DVT) or pulmonary embolism (PE) was detected in either group during the observation period. No significant difference was detected regarding perioperative complications or whether patients were able to be discharged home instead of to a post-inpatient facility (Figure 2). There was no significant difference in component position, complications, or readmissions between groups. Total cost per hip was significantly less for the simultaneous ($15,565 +/− 1,470) compared to the sequential group ($19,602 +/− 3,094) (p<0.001). There was no significant difference in total payments between the simultaneous group ($25,717 +/− 4,404) and the sequential group ($24,926 +/− 8,203) (p=0.93). Thus, with lower cost and similar reimbursement, profit per hip was significantly higher for the simultaneous ($9,606 +/− 5,060) compared to the sequential group ($5,324 +/− 7,997) (p<0.05). (Figure 3).
Conclusions
Significant data regarding simultaneous bilateral THA has been published but results are conflicting and different surgical approaches were used. To our knowledge only four previous reports have been published examining simultaneous bilateral THA performed via the DAA. While simultaneous DAA THA presents challenges, our results suggest that simultaneous DAA THA may add value to the healthcare system without resulting in increased complications compared to sequential hip arthroplasty.
