Post-traumatic osteonecrosis of the femoral head (ONFH) is a major complication of femoral neck fractures that require numerous solutions. The purpose of the current study is to investigate the effects of platelet-rich plasma (PRP) incorporated autologous granular bones graft for the treatment of pre-collapse stages (ARCO stage II-III) of post-traumatic ONFH.

A total of 46 patients were eligible and enrolled into the study. 24 patients were treated with core decompression and PRP incorporated autologous granular bones graft (treatment group: 9 females and 15 males, age range, 16–39 years), and 22 patients with core decompression and autologous granular bones graft (control group: 6 females and 16 males, age range, 18–42 years. During a minimum duration of follow-up of 36 months, multiple imaging techniques including X-ray and computed tomography (CT) scanning were used to evaluate the radiological results, and Harris hip score (HHS) and the visual analogue scale (VAS) were chosen to assess the clinical results.

Both treatment group and control group had a significant improved HHS (P < 0.001). The minimum clinically important difference (MCID) for HHS was reached in 91.7% of treatment group and 68.2% of control group (P = 0.0449). HHS in treatment group was significantly higher than control group at the last follow-up (P = 0.0254). VAS score was significantly declined in treatment group when compared with control group (P = 0.0125). Successful clinical results were achieved in 21 of 24 patients (87.5%) in treatment group compared with 13 of 22 patients (59.1%) in control group (P = 0.0284). Successful radiological results were achieved in 19 of 24 patients (79.2%) in treatment group compared with 11 of 22 patients (50%) in control group (P = 0.0380). The survival rates using requirement for further hip surgery as an endpoint were higher in treatment group in comparison to control group (P = 0.0260).

The PRP incorporated autologous granular bones graft is a safe and effective procedure for the treatment of pre-collapse stages (ARCO stage II-III) of post-traumatic ONFH.

Objectives

The purpose of the present study was to describe the long-term results of THA for ONFH in patients with SLE.

[Background]

Bipolar hemiarthroplasty (following BHA) have historically had poor results in patients with idiopathic osteonecrosis of femoral head (OFNH). However, most recent report have shown excellent results with new generation BHA designs that incorporate advances in bearing technology. These optimal outcomes with bipolar hemiarthroplasty will be more attractive procedure for young patients who need bone stock for future total arthroplasty. The purpose of the current study was to evaluate the clinical and radiographic finding of this procedure for the treatment of OFNH at our institution after 7-to 21years follow-up.

Purpose

Proximal femoral osteotomy is an attractive joint preservation procedure for osteonecrosis of the femoral head. The purpose of this study was to investigate the cause of failure of proximal femoral osteotomy in patients with osteonecrosis of the femoral head.

Background

Core decompression (CD) is effective to relieve pain and delay the advent of total hip arthroplasty (THA) for osteonecrosis of the femoral head (ONFH). However, the influence of CD on the subsequent THA has not been determined yet.

Background

The short stem prosthesis showed good results in patients with primary osteoarthritis. However, there were a few studies about the short stem THA in patients with osteonecrosis of the femoral head (ONFH).

Introduction

Collapse of femoral head associated with end-stage arthritis form hallmark of osteonecrosis of femoral head. Purpose was to assess efficacy of platelet rich plasma following core decompression in early stage of osteonecrosis of femoral head.

Introduction

Patients with osteonecrosis of the femoral head are typically younger, more active, and often require high rates of revision following primary total hip arthroplasty. However, outcomes of revision hip arthroplasty in this patient population have been rarely reported in the literature. The purpose of this study was to report the intermediate-term clinical and radiographic outcomes of revision hip arthroplasty in patients with osteonecrosis of the femoral head.

Introduction

The natural history of osteonecrosis of the femoral head (ONFH) is not cleanly understood, but most of them progresse to the joint destruction and requires total hip replacement arthroplasty. There are several head preserving procedure, but no single therapeutic method proved to be effective in preventing progression of the disease. The possibility has been raised that implantation of bone marrow containing osteogenic precursors may be effective in the treatment of this disease. However, there are no long-term follow-up results of cell therapy for ONFH. AS far as we know, there are no reports about bone graft and cell therapy for ONFH. Therefore, we performed a prospective clinical and radiological evaluation on ONFH treated with core decompression combined with autoiliac bone graft and an implantation of autologous bone marrow cells as a therapeutic method of ONFH.

Introduction

The pathophysiology of osteonecrosis of femoral head (ONFH) is uncertain for most cases with speculation of vascular impairment and changes in cell biology due to multi-factorial etiologies including corticosteroid, alcohol, smoking, trauma, radiation or caisson disease and genetic. Extracorporeal shockwave therapy (ESWT) began with an incidental observation of osteoblastic response pattern during animal studies in the mid-1980 that generated an interest in the application of ESWT to musculoskeletal disorders. The mechanism of shockwave therapy is not fully understood but several reports showed better clinical outcomes and promoted bone remodelling and regeneration effect of the femoral head after ESWT in ONFH. Therefore, we compared the clinical results of the use of extracorporeal shock wave therapy (ESWT) on the patients with ONFH in radiographic staging.

Post-traumatic avascular necrosis of the femoral head usually occurs after hip dislocation and femoral neck fracture. Recently along the development of hip arthroscopy, early stage of avascular necrosis of the femoral head can be treated rthroscopically. We hereby present two cases of post-traumatic avascular necrosis patients treated with hip arthroscopy. Case 1. Twenty one year old female patient came to the hospital because of fall from height of 3 floors. Left acetabular fracture, both superior pubic rami fractures and severely displaced left femoral neck fracture were identified at the emergency department (Fig. 1-A). She underwent surgery at the injury day. After the repair of ruptured urinary bladder, internal fixation of the femoral neck was done. Four cannulated screws with washers were inserted for displaced femoral neck fracture, consistent with garden stage IV (Fig. 1-B). Skeletal traction of ipsilateral lower extremity was applied four weeks after the surgery for acetabular fracture. She visited us for painful limitation of motion on left hip at eight months postoperatively. Plain radiograph showed collapse of femoral head and osteophyte formation which were caused by post-traumatic avascular necrosis (Fig. 1-C,D). Femoral head was perforated by a screw. She was planned to remove the screw and resect the osteophyte arthroscopically. On arthroscopic examination, severe synovitis and folded, collapsed femoral cartilage were identified (Fig. 1-E). Screws were removed and osteophyte were also resected (Fig. 1-F). We filled the cavity caused by the screws with allogenic strut graft for structural support. After the surgery, pain was relieved and she came back to her active daily living and for six months, no other complication nor further collapse were identified postoperatively. Case 2. Fourty year old male patient was admitted to the hospital for fall from height about fifteen feet from the ground. Left femoral neck fracture was identified on the emergency department. Previously he had underwent intramedullary nailing for the femoral shaft fracture about five years ago. Urgent internal fixation with four cannulated screws was done on the day of injury. The fixation was unsatisfactory because previously inserted intramedullary nail hindered the proper trajectory of screws. Furthermore, direction of cephalad interlocking holes of the nail were not consistent with the anteversion of femoral neck, we could not place the screws through the nail. Four months after the index surgery, collapse of femoral head and loosening of screws have occurred. MRI showed the collapse of femoral head and posttraumatic avascular necrosis. Prominent bony beak of femoral neck were identified and he complained difficulty and pain on his hip during abduction. We left two screws for secure fixation and resected the bony beak using arthroscopic burr. After the surgery, he felt free from the pain on abduction of hip. Discussion. Even though collapse of the femoral head is identified, early intervention by the arthroscopy could minimize pain or delay the progression of arthritic change. Authors think that it might be helpful for the young adult patients in terms of pain relief and potential delay of the total hip arthroplasty

Introduction. Venous thromboembolism (VTE) is one of the common complications after total hip replacements (THRs). To reduce the risk of VTE, early rising, active movement of the foot, the use of a foot pump or graduated compression stockings and prophylactic administration of anticoagulant drugs are important. Further, intraoperative factors should be taken intoãζζconsideration. Objective. The objective of this study is to assess the influence of surgical approaches, which are a modified Watson-Jones approach and a posterolateral approach, on the frequency of VTE after primary THRs. Materials and Methods. One hundred seventy-five patients underwent 199 primary total hip replacements by a single surgeon using modified Watson-Jones approach between gluteus medius muscle and tensor fascia lata (AL Group). The average age at the operation was 63.4 ±12.5 years old. The average BMI was 23.6±3.6. The original diagnosis consisted of 151 cases of osteoarthritis of the hip, 34 cases of avascular necrosis of the femoral head, 7 cases of rheumatoid arthritis and two cases of rapidly destructive coxopathies. Control group was 159 primary total hip replacements by a single surgeon using posterolateral approach (PL Group). The average age at the operation was 63.0±11.3 years old. The average BMI was 22.8±3.6. The original diagnosis consisted of 130 cases of osteoarthritis of the hip, 17 cases of avascular necrosis of the femoral head, 7 cases of rheumatoid arthritis and four cases of rapidly destructive coxopathies. VTE was detected by contrast computed tomography or ultrasound, and soluble fibrin monomer complex (SF) was measured on the first day after surgery. Results. The frequency of VTE was thirty three of 199 cases (16.6%) in the AL Group. On the other hand, the frequency of VTE was sixty three of 159 cases (39.6%) in the PL Group. The average value of SF on the first day after surgery was 16.1±28.1 in the AL Group, 15.4±20.6 in the PL Group, respectively. In each group, the SF values showed a significant difference between VTE detected cases (41.7±55.3 in the AL Group; 24.2±26.4 in the PL Group) and VTE non-detected ones (10.9±13.6 in the AL Group; 9.4±12.4 in the PL Group) by Mann-Whitney U test. Conclusion. Modified Watson-Jones approach is useful to reduce the risk of VTE, compared with posterolateral approach. The foot position to obstruct blood flow during THRs using poterolateral approach may be the risk factor for VTE

Background and aim. Total hip replacement (THR) in young patients has been associated to higher revision rates than in older population. Different conditions may lead to end-stage arthritis of the hip in these patients. We compared the clinical and radiological outcome of two different groups of young and very young patients who underwent a ceramic-on-ceramic THR. Patients and Methods. 120 hips were prospectively followed for a mean of 10.4 years (range, 5 to 17). 38 patients (46 hips) were less than 30 years old (group 1), and, 68 (74 hips) were between 31 and 40 years old (group 2). Weight (p<0.001) and physical activity level were greater in group 2 (p<0.001). Preoperative function (p=0.03) and range of mobility (p=0.03) were worse in group 1. Primary osteoarthritis was not found in any case. Rheumatoid juvenile arthritis was the most frequent diagnosis in group 1 and avascular necrosis of the femoral head in group 2. A femoral funnel-shaped type 1 according to Dorr was more frequent in group 2 (p=0.04). The same ceramic-on-ceramic uncemented THR was used in all cases. Screws for cup fixation were only used when strictly needed. We analysed the clinical results according to the Merle-D´Aubignè and Postel scale, the postoperative radiological reconstruction of the hip and the radiological appearance of cup loosening. Kaplan-Meier survivorship analysis was used to estimate the cumulative probability of not having a revision surgery. Results. Screw use required to obtain a secured interference fit of the acetabular component was found more frequently in group 1 (p=0.01). Postoperative pain (p=0.002) and function (p=0.002) were better in group 1. Mean acetabular abduction angle of the cup was greater in group 1 (p=0.03) and reconstruction to the hip rotation center according to Ranawat (p=0.01) was better in group 2. Placement of the acetabular component inside the Lewinnek´s zone and stem position were similar in both groups. No hips were revised due to complications related to ceramic or to stem loosening. Three cups were revised for aseptic loosening in group 1 and four in group 2. The survival rate for cup aseptic loosening at 15 years was 92.3% (95% CI: 83.7 to 100) for group 1 and 93.1% (95% CI: 85.3 to 99.9) for group 2 (Log rank, p=0.88). Conclusion. Ceramic-on-ceramic uncemented THR is an excellent option for young and very young patients. Despite worse preoperative conditions in patients under the age of 30 years, a similar clinical outcome was found in this series

The Birmingham hip resurfacing (Smith & Nephew, Tennessee) (BHR) has been used in younger more active patients. Aim. We report on our experience of 206 BHR procedures in patients aged 50 years or less with a minimum ten year follow-up. Clinical outcome scores, body mass index (BMI), gender and age were analysed to investigate resurfacing outcomes. Methods. 200 patients (158 males and 42 females) with an average operation age of 43.33 years (SD ±5.66) were investigated. There were 6 bilateral procedures The mean follow-up period was 12.44 years (SD ±1.71). The arthroplasties were completed between April 1999 and December 2002 by one surgeon. Data and outcome measurements were collected prospectively and analysed retrospectively. We evaluated Harris Hip Scores, Short Form-36 (SF-36v2) Scores, Tegner Activity Score Scores and McMaster Universities Osteoarthritis Index Scores (WOMAC) comparatively at preoperative, six month and yearly intervals. Results. In 1 patient the implant was in situ at the time of death. Revision was carried out in 5 hips (2.4%) at a mean time period of 3.2 years (0–8) post-operatively. Failure was due to femoral neck fracture, acetabular loosening and avascular necrosis of the femoral head, leading to loosening. Kaplan-Meier analysis showed survivorship of 97.6%. The mean Harris Hip scores (paired t-test, p<0.05) improved significantly from 55.58 preoperatively to 91.33 at 15 years. The mean SF-36v2 physical scores (paired t-test, p<0.05) improved significantly from 32.70 preoperatively to 43.75 at 15 years. WOMAC total scores (paired t-test, p<0.05) improved significantly from 44.37 preoperatively to 14.67 at 15 years. Conclusion. In this demanding group of patients, without any restrictions to physical activity, the results of this procedure at 10 years are most encouraging. However, concerns remain in relation to the effect of elevated metal ions, tissue sensitivities, and anatomical variations, such as hip dysplasia, which may impact on function and success

Osteonecrosis of the femoral head (ONFH) is a debilitating, painful, progressive, and refractory disease that has multiple etiologic risk factors. It is caused by bone cell death, which itself has various causes, leading to femoral head collapse and subsequent osteoarthritis. ONFH primarily influences patients aged from 20 to 50 years; in addition, bilateral hip joints are involved in 75% of patients. Causes include use of corticosteroids, alcohol abuse, previous trauma, hemoglobinopathy, Gaucher disease, coagulopathies, and other diseases. No pharmacologic treatment has been shown to be effective for early ONFH. Outcomes of total hip arthroplasty (THA) for these young and active patients have some drawbacks, primarily due to the young age of these patients, limited lifetime and durability of the implants and their fixation, and the skeletal manifestations of osteonecrosis. As a result of these concerns, there has been an increased focus on early interventions for ONFH aimed at preservation of the native articulation. Core decompression is currently the most widely accepted surgical treatment at the early stage of avascular osteonecrosis (AVN); however, due to limited efficacy, its use has been debated. There is currently no standardised protocol for evaluating and treating osteonecrosis of the femoral head in adults in the United States. Although total hip replacement is the most frequent intervention for treatment of post-collapse (Steinberg stage-IIIB, IVB, V, and VI) osteonecrosis; core decompression is the most commonly offered intervention for symptomatic, pre-collapse (Steinberg stage-IB and IIB) osteonecrosis. Less frequently offered treatments include non-operative, pharmacologic or modality management, osteotomy, vascularised and non-vascularised bone-grafting, hemiarthroplasty, resurfacing and arthrodesis. A promising, minimally invasive, core decompression procedure combined with a mesenchymal stem cell grafting technique which restores vascularity and heals osteonecrotic lesions has become popularised. This procedure is called a bone marrow aspirate concentrate (BMAC) procedure. During a BMAC, mesenchymal stem cells (in the form of concentrated iliac crest bone marrow) are injected through a core decompression tract into the area of necrosis in the femoral head. Most patients with early (pre-collapse) disease have excellent results at 2 to 5 years of clinical follow-up. Patients are weight bearing as tolerated on crutches after the procedure for 6 weeks, and are able to go home on the same day or next day after surgery with minimal pain. We can report on the early, promising results of 300 patients with ONFH treated with BMAC in the United States by two expert hip surgeons with at least 75%-80% survivorship. The care of adults with osteonecrosis of the femoral head is highly variable. This paper will discuss the various non-operative and operative treatment algorithms for ONFH available today. We will also report on a promising, new technique (BMAC), which improves the efficacy of traditional core decompression for early ONFH. The goal of treatment of early ONFH is to avoid THA in young, active patients and this talk will discuss those interventions and treatments which help accomplish that goal

Re-positioning osteotomy in the treatment of un-united fracture neck of femur in young patients improves the biomechanical pre-conditions to promote bone union of the Pseudarthrosis. This operative procedure is the method of choice for Pseudarthrosis of the neck of the femur with a viable femoral head. It is also the method of choice in children and in adolescents even if there is avascular necrosis of the femoral head. The operative technique permits exacts planning, stable osteosynthesis both of the un-united fracture of the neck of the femur as well as the osteotomy and allows early mobilisation. In this series of 56 cases, only six (10%) had collapse of the femoral head due to avascular necrosis, six (10%) patients had severe pain in the hip and nine (16%) patients had severe restriction of hip movement. The overall success of the operation in this series was 84%

A large number of short stem prosthesis for hip arthroplasty has been introduced in the last years. The main aim of this device is to preserve the proximal bone stock in order to facilitate revisions in the future. Furthermore there is an increase in young and active patients in total hip arthroplasty that's why it's important to consider minimally invasive, muscle-considering procedures. Short stems allow to make minimal invasive approaches easier and improve the biomechanical reconstruction. However, there is a large increase of publication about short stems there is still little data about survival and revision rates. We report about the outcome of 81 patients, who have recieved NANOS short stem prosthesis between October 2012 and April 2014. The average age of the patient was 61,6. The oldest patient was 78 years old and our youngest patient was 41 years old. The main diagnoses were osteoarthritis in 67 patients, dysplastic osteoarthritis in 8 patients and avascular necrosis of the femoral head in 6 patients. We have included 37 female patients and 44 male patients. 3 patients had the surgery on both sides. The average operating time was 75,2 min ± 20,1 min and the average grading of patients for surgical procedures of the American Society of Anesthesiologists was 1,8±0,7. The patients were hospitalized 9,6 days ± 2,9 days. The average BMI was 28,2±5,2. Along with demographic data and co-morbidities, the Harris Hip Score was recorded pre-operatively and at follow-up. The Harris Hip Score increased from 36,6 ± 14,5 pre-operatively to 94,5 ± 8,8 at the final follow-up. None of the 81 stems were revised this corresponds to a to a survival rate of 100%. Two of the patients suffered from a hip dislocation which was treated in both cases conservative. In further consequence unfortunately one of those patients thrombosed and suffered from a pulmonary embolism. The x-rays haven't shown any radiolucent lines in any patients. All in all our patients reported about an high post-operative satisfaction. The clinical and radiographic results encouraged us to continue to use short stems with metaphyseal anchorage. However, there must be more long-term results to confirm our excellent mid term results

Total hip arthroplasty (THA) is frequently performed as a salvage procedure for the acetabular fracture when posttraumatic osteoarthritis, posttraumatic avascular necrosis, or fixation failure with subluxation develop. Special considerations for this situation include previous surgical exposure with dense scar tissue, the type and location of implants, the location and amount of heterotopic ossification, indolent infection, previous sciatic nerve palsy, and the pathoanatomy of existing acetabular defect. These factors can influence the choice of surgical exposure and the reconstructive method. The outcomes of THA after acetabular fracture are generally less favorable than those of the nontraumatic degenerative arthritis. Reason for this high failure is the low mean age and the high activity level of the patient. Other important reasons for failure include the problem of acetabular bone deficiency and compromised bone quality. We evaluated the results of cementless THA in patient who had previous acetabular fracture. We also compared this result with those of patients with posttraumatic avascular necrosis of the femoral head. Forty-five consecutive cementless THAs were performed for the treatment of post-traumatic osteoarthritis after acetabular fracture between December 1993 and December 2008. Of these patients, 15 patients were died or lost to follow-up monitoring before the end of the minimum one year follow-up period. This left 30 patients (30 hips) as the subjects of our retrospective review. We evaluated the clinical and radiographic results of these patients and compared with the results of THA in patients with post-traumatic AVN of the femoral head which had without acetabular damage. Two hips required revision of the cup secondary to early migration of the acetabular cup (1 hip) and postoperative deep infection (1 hip). There was no significant difference in clinical and radiographic results between two groups except implanted acetabular component size and required bone graft (p<0.05). The Kaplan-Meier ten-year survival rate, with revision as the end-point, was 90% and 96.7% with loosening of acetabular component as the end-point. Our series suggested that compared with cemented components, uncemented sockets may improve the results of arthroplasty after previous acetabular fracture. In conclusion, cementless THA following acetabular fracture presents unique challenge to the surgeon, careful preoperative assessment and secure component fixation with proper bone grafting is essential to minimize problems

Avascular necrosis (AVN) of the femoral head is a potentially devastating complication of treatment for developmental dysplasia of the hip (DDH). AVN most commonly occurs following operative management by closed (CR) or open reduction (OR). This occurrence has frequently been examined in single centre, retrospective studies, however, little high-level evidence exists to provide insight on potential risk factors. The purpose of this observational, prospective multi-centre study was to identify predictors of AVN following operatively-managed DDH. A multi-centre, prospective database of infants diagnosed with DDH from 0–18 months was analyzed for patients treated by CR and/or OR. At minimum one year follow-up, the incidence of AVN (Salter criteria) was determined from AP pelvis radiographs via blinded assessment and consensus discussion between three senior paediatric orthopaedic surgeons. Patient demographics, clinical exam findings and radiographic data were assessed for potential predictors of AVN. A total of 139 hips in 125 patients (102 female, 23 male) underwent CR/OR at a median age of 10.4 months (range 0.7–27.9). AVN was identified in 37 cases (26.6% incidence) at a median 23 months post-surgery. Univariate logistic regression analysis comparing AVN and no AVN groups identified sex, age at diagnosis, age at surgery, pre-surgery IHDI grade and time between diagnosis and surgery as potential predictive factors. Specifically, male sex (OR 2.21 [0.87,5.72]), IHDI grade IV, and older age at diagnosis (7.4 vs. 9.5 months) and surgery (10.2 vs. 13.6 months) were associated with development of AVN. Likewise, increased time between diagnosis and surgery (2.9 vs. 5.5 months) was also associated with a higher incidence. No association was found with surgery type (CR vs. OR), pre-surgery acetabular index or surgical hip. Development of AVN occurred in 26.6% of hips undergoing CR or OR at a median 23 months post-surgery. Male sex, older age at diagnosis and surgery, dislocation severity and increased time between diagnosis and surgery were associated with AVN. Longer-term follow-up and larger numbers will be required to confirm these findings. Early outcomes from this prospective patient cohort suggest that AVN is an important complication of operative management for DDH, and appears to occur at a comparable rate whether the reduction is performed open or closed. Male patients may be more susceptible to developing AVN and merits further exploration. Potential predictive factors of older age and length of time between diagnosis and surgery emphasize the importance of early detection and treatment to minimize complications and optimize outcomes

Purpose. Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ) is subjective assessment of coxarthropathy and reflects the satisfaction level of the patient. Recently, the use of JHEQ as a postoperative assessment of total hip arthroplasty (THA) has become widespread. The aim of this study was to investigate the clinical outcomes of bilateral simultaneous THA through the direct anterior approach (DAA) using JHEQ. Methods. This study included 34 patients (41 hips) who were treated with first THA at our hospital from January to March 2013 and were available for evaluation of clinical outcomes 1 year after surgery. Of these, 7 (2 males and 5 females; mean age, 54.7 years) underwent bilateral simultaneous THA (group B), and 27 (2 males and 25 females; mean age, 64.2 years) underwent unilateral THA (group U). Thirty patients were preoperatively diagnosed with hip osteoarthritis, and 4 were diagnosed with avascular necrosis of the femoral head. All patients were treated through DAA in a supine position under general anaesthesia. Items for evaluation included clinical outcomes, Japanese Orthopaedic Association Hip score (JOA score) and JHEQ. Results. Average operative time per hip was 45.9 min (range, 34–79 min) in group B and 44.2 min (range, 32–71 min) in group U. Average blood loss was 221.4 g (range, 40–1040 g) in group B and 386.9 g (range, 70–1300 g) in group U. No major complications such as dislocation, bone fracture, nerve palsy or venous thromboembolism were observed. The average JOA score improved from 45.1 preoperatively to 93.7 at 1 year postoperatively in group B and from 47.2 preoperatively to 92.3 at 1 year postoperatively in group U. Average total JHEQ (pain/motion/mental status) improved from 21 (preoperative, 12/2/7) to 75 (1 year postoperatively, 27/23/25) in group B and from 26 (preoperative, 10/7/10) to 69 (1 year postoperatively, 25/21/24) in group U. Discussion. Bilateral simultaneous THA was proactively performed when indicated at our hospital. In the present study, we observed greater improvement in JHEQ in patients treated with bilateral simultaneous THA than in those treated with unilateral THA. These findings suggest that bilateral simultaneous THA results in greater postoperative satisfaction of the patient