Introduction. Perioperative hospital adverse events are an issue that every surgeon endeavors to avoid and minimize as much as possible. Even “minor events” such as fever or tachycardia may lead to significant costs due to workup tests, inter-consultations, and/or increased hospital stay. The objective of this study was compare perioperative outcomes (hospital length of stay [LOS], discharge disposition), rates of in-hospital adverse events and transfusion, and postoperative readmission and reoperation rates for simultaneous and staged bilateral direct anterior total hip arthroplasty (DA-THA) patients. Methods. A retrospective chart review was conducted on a consecutive series of 411 primary bilateral DA-THAs performed between 2010 and 2016 at a single institution by two fellowship trained surgeons. These were categorized as: (1) simultaneous (same anesthesia, n=122) and (2) staged (different hospitalizations, n=289). The mean time between staged surgeries was 468 days (± 414 days). Baseline patient demographics as well as hospital LOS, discharge disposition (home vs. other), hospital adverse events (i.e., nausea, vomiting, tachycardia, fever, confusion, pulmonary embolism, etc.), blood transfusions, and unplanned hospital readmissions and reoperations within 90 days were collected. Groups were compared using independent –tests, Fisher's exact test, and Pearson Chi-Square. Results. Overall, the baseline patient characteristics of the simultaneous DA-THA group had significantly younger patients, a higher proportion of males, and twice the proportion of patients with ASA 1 status compared with the staged DA-THA group. The simultaneous group showed statistically significant longer LOS (2.6 vs. 1.8 days, p<0.001) and an increased proportion of patients discharged to an extended care facility (23% vs. 5.9%, p<0.001). The overall rate of hospital adverse events in the series was 136/411 (33.1%), with a higher rate in the simultaneous DA-THA patients (54.1% vs. 24.2%, p<0.001). Transfusion rate was higher in the simultaneous DA-THA group (45.9%) compared to the staged group (6.9%) (p<0.001). There were no readmissions and a single reoperation in the staged DA-THA group at 90 days postoperative. Conclusion. These data show that bilateral DA-THAs performed in a staged fashion, rather than simultaneously, have a shorter hospital LOS and decreased rates of hospital adverse events and transfusions

Short stems have been developed to conserve bone stock, especially in younger populations undergoing a total hip arthroplasty (THA), and showed similar functional outcomes compared to conventional stems. Recent literature suggested that stem length might be an independent risk factor for acute periprosthetic femoral fracture in direct anterior THA (1) or with different short stem designs (2). The purpose of the present study was to compare the incidence of acute periprosthetic femoral fractures, between stems of the same manufacture (Taperloc microplasty vs Taperloc complete), which have the same stem characteristics, except for the stem length which is 35 mm shorter in Taperloc microplasty during posterior and lateral THA. Our institution's arthroplasty database was searched for all primary total hip arthroplasties utilizing short femoral stems performed between August 2016 and August 2023. Pre-operative X-rays for each case were analysed to characterize the proximal femoral geometry, specifically the canal bone ratio (CBR) and canal flare index (CFI). Data analysis was performed to identify risk factors for periprosthetic fractures. For the time period assessed, 2107 femoral stems (Taperloc Microplasty:1727, Taperloc complete: 380) were implanted. Females constituted 53% of the cohort. The average patient age was 70±11 years. The periprosthetic fracture rate was 0.94%, with 20 periprosthetic fractures (Taperloc Microplasty:17, Taperloc complete: 3) excluding 2 greater trochanteric fractures (1 at each group), identified at follow-up of three months. There was no significant difference between the periprosthetic fracture rates between the two stems (0.98% vs 0.79%, p>0.72) The multivariate regression analysis demonstrated that the stem length, CBR, CFI, age, and gender were not risk factors for periprosthetic fracture. The present study demonstrated that both Taperloc Microplasty and Taperloc complete stems had similar rates of periprosthetic fractures, and the stem length was not a risk factor for a periprosthetic fracture during uncemented THA. 1. Tamaki T, Cementless Tapered-Wedge Stem Length Affects the Risk of Periprosthetic Femoral Fractures in Direct Anterior Total Hip Arthroplasty. J Arthroplasty. 2018 Mar;33(3):805-809. 2. Staunton P. Acute Periprosthetic Hip Fracture with Short Uncemented Femoral Stems. J Arthroplasty 2024 accepted

Background. Despite growing interest in direct anterior approach total hip arthroplasty, perioperative femoral fracture and early aseptic loosening are increasingly recognized complications. Previous research has documented the role of surgeon experience in association with these femoral complications. The purpose of this study was to explore the relationship between femoral component design and early periprosthetic femoral complications. Methods. This was an extension of previous work with an updated patient cohort of 5090 consecutive direct anterior primary total hip arthroplasties at a single institution with a single-taper, wedge femoral stem with 4 variants involving length and geometry: Group 1) full length, standard profile; Group 2) full length, reduced distal profile; Group 3) short length, standard profile; and Group 4) short length, reduced distal profile. Records were reviewed retrospectively for the incidence of early periprosthetic fracture or aseptic loosening and analyzed with regard to patient demographics and femoral stem type. Results. There were 42 (0.83%) periprosthetic femur complications observed in the early postoperative period. Increased age (p<0.001) and female gender (p=0.023) were significantly associated with incidence of femoral complications in univariate analysis, while age maintained this significant relationship in multivariate analysis (P<0.001). There was a trend toward increased complication rate in patients receiving a short stem with full profile taper (1.27%, p=0.0539). Conclusion. Despite an overall low rate of femoral complications after direct anterior total hip arthroplasty, the risk is increased in elderly patients and females. Furthermore, femoral stem design may portend an elevated risk of these complications