Section of Surgical Pathophysiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark,
Arch Orthop Trauma Surg. 2013 Nov;133(11):1601-5. doi: 10.1007/s00402-013-1829-z. Epub 2013 Aug 4.
Bilateral total hip arthroplasty (BTHA) and bilateral simultaneous total hip arthroplasty (BSTHA) are done increasingly. Previous studies evaluating outcomes after bilateral procedures have found different results. The aim of this study was to investigate length of hospital stay (LOS), 30 days readmissions and 90 days mortality after BSTHA and BTHA on a nationwide basis.
All bilateral primary total hip arthroplasties performed in Denmark from January 1, 2010 to June 31, 2011 were identified using data from the Danish National Patient Registry. The staged procedures were divided into early staged BTHA (0-6 months) and late staged BTHA (6-18 months).
103 patients underwent BSTHA, 370 underwent BTHA (0-6 months) and 207 underwent BTHA (6-18 months). Median total LOS was 4 days (IQR 3) after BSTHA vs. 6 days (3) after both BTHA (0-6 months) and BTHA (6-18 months) (p < 0.001). There were no deaths in the BSTHA group vs. 1 death in each BTHA group ≤90 days postoperatively (0.3 and 0.5 %, respectively) (p = 0.755). The readmission rate ≤30 days was 1.9 % after BSTHA vs. 8.9 % (cumulated) after BTHA (0-6 months) and 15.9 % (cumulated) after BTHA (6-18 months) (p < 0.001).
If patients are carefully selected for BSTHA, the procedure appears to be safe when combined with a fast-track protocol in Denmark. We found significantly lower readmission rates and shorter total LOS in the BSTHA group compared with the BTHA groups, potentially reflecting selection bias. The results should stimulate to evaluate BSTHA in a randomised controlled trial or a detailed prospective, large multicenter study with a fast-track protocol regarding morbidity, convalescence and mortality.
双侧全髋关节置换术（BTHA）和双侧同期全髋关节置换术（BSTHA）的应用日益增多。既往评估双侧手术结果的研究得出了不同的结论。本研究旨在基于全国范围调查 BSTHA 和 BTHA 后住院时间（LOS）、30 天再入院率和 90 天死亡率。
通过丹麦全国患者登记处的数据，确定了 2010 年 1 月 1 日至 2011 年 6 月 31 日期间所有在丹麦进行的双侧初次全髋关节置换术。分期手术分为早期分期 BTHA（0-6 个月）和晚期分期 BTHA（6-18 个月）。
103 例患者行 BSTHA，370 例患者行 0-6 个月 BTHA，207 例患者行 6-18 个月 BTHA。BSTHA 后总 LOS 中位数为 4 天（IQR 3），而 0-6 个月 BTHA 和 6-18 个月 BTHA 后总 LOS 中位数为 6 天（IQR 3）（p<0.001）。BSTHA 组无死亡，而 0-6 个月 BTHA 组和 6-18 个月 BTHA 组各有 1 例术后 90 天内死亡（0.3%和 0.5%）（p=0.755）。BSTHA 后 30 天内再入院率为 1.9%，0-6 个月 BTHA 组和 6-18 个月 BTHA 组的累积再入院率分别为 8.9%（cumulated）和 15.9%（cumulated）（p<0.001）。
如果患者被仔细选择行 BSTHA，在丹麦采用快速康复方案时，该手术似乎是安全的。与 BTHA 组相比，BSTHA 组的再入院率和总 LOS 显著更低，这可能反映了选择偏倚。这些结果应刺激在随机对照试验或详细的前瞻性、大型多中心研究中评估 BSTHA，采用快速康复方案评估发病率、康复和死亡率。
