Houdek Matthew T, Wyles Cody C, Watts Chad D, Wagner Eric R, Sierra Rafael J, Trousdale Robert T, Taunton Michael J
1Mayo Clinic, Rochester, Minnesota.
J Bone Joint Surg Am. 2017 Jan 4;99(1):48-54. doi: 10.2106/JBJS.15.01223.
There is debate regarding the role of single-anesthetic versus staged bilateral total hip arthroplasty (THA) for patients with end-stage bilateral osteoarthritis. Studies have shown that single-anesthetic bilateral THA is associated with systemic complications, but there are limited data comparing patient outcomes in a matched setting of bilateral THA.
We identified 94 patients (188 hips) who underwent single-anesthetic bilateral THA. Fifty-seven percent of the patients were male. Patients had a mean age of 52.2 years and body mass index of 27.1 kg/m. They were matched 1:1 on the basis of sex, age (±1 year), and year of surgery (±3 years) to a cohort of patients undergoing staged bilateral THA. In the staged group, there was <1 year between procedures (range, 5 days to 10 months). Mean follow-up was 4 years for each group.
Patients in the single-anesthetic group experienced shorter total operating room time and length of stay. There was no difference (hazard ratio [HR] = 0.73, p = 0.50) in the overall revision-free survival in patients undergoing single-anesthetic or staged bilateral THA. The risks of reoperation (HR = 0.69, p = 0.40), complications (HR = 0.83, p = 0.48), and mortality (HR = 0.47, p = 0.10) were similar. Single-anesthetic bilateral THA reduced the total cost of care (by 27%, p = 0.0001).
In this matched cohort analysis, single-anesthetic bilateral THA was not associated with an increased risk of revision, reoperation, or postoperative complications, while decreasing cost. In our experience, single-anesthetic bilateral THA is a safe procedure that, for certain patients, offers an excellent means to deal with bilateral hip osteoarthritis.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
对于终末期双侧骨关节炎患者，单麻醉一次完成双侧全髋关节置换术（THA）与分期双侧THA的作用存在争议。研究表明，单麻醉一次完成双侧THA与全身并发症相关，但在双侧THA匹配情况下比较患者预后的数据有限。
我们纳入了94例行单麻醉一次完成双侧THA的患者（188髋）。57%的患者为男性。患者的平均年龄为52.2岁，体重指数为27.1kg/m²。根据性别、年龄（±1岁）和手术年份（±3年），将他们与分期双侧THA患者队列进行1:1匹配。在分期组中，两次手术之间间隔<1年（范围为5天至10个月）。每组的平均随访时间为4年。
单麻醉组患者的总手术室时间和住院时间较短。接受单麻醉或分期双侧THA的患者在总体无翻修生存率方面无差异（风险比[HR]=0.73，p=0.50）。再次手术风险（HR=0.69，p=0.40）、并发症风险（HR=0.83，p=0.48）和死亡率（HR=0.47，p=0.10）相似。单麻醉一次完成双侧THA降低了护理总成本（降低27%，p=0.0001）。
在这项匹配队列分析中，单麻醉一次完成双侧THA与翻修、再次手术或术后并发症风险增加无关，同时降低了成本。根据我们的经验，单麻醉一次完成双侧THA是一种安全的手术方法，对于某些患者来说，是治疗双侧髋关节骨关节炎的极佳手段。
治疗性三级证据。有关证据级别的完整描述，请参阅作者指南。
