Poultsides Lazaros A, Triantafyllopoulos Georgios K, Memtsoudis Stavros G, Do Huong T, Alexiades Michael M, Sculco Thomas P
Division of Adult Reconstruction and Joint Replacement, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York.
Department of Anesthesiology, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York.
J Arthroplasty. 2017 Oct;32(10):2974-2979.e1. doi: 10.1016/j.arth.2017.05.028. Epub 2017 May 23.
Management strategies for bilateral hip degenerative disease include same-day or staged bilateral total hip arthroplasty (THA), but information on outcomes remains sparse. We sought to describe in-hospital complications and blood transfusion rates after same-day and staged bilateral THAs at different time intervals and to assess risk factors for these events.
We retrospectively reviewed administrative data for 3785 patients treated with same-day bilateral (n = 1946; group A) and staged bilateral THA within (1) 0-3 months apart (n = 328; group B); (2) 3-6 months apart (n = 703; group C); and (3) 6-12 months apart (n = 808; group D), between 1999 and 2014. We recorded demographics, the Charlson-Deyo comorbidity index and in-hospital local and systemic (minor and major) complications. Complication and blood transfusion rates among groups were compared. A logistic regression model was developed to identify risk factors for major complications.
Local complications were rare. Minor complications were less frequent in group A (P < .001). Major complications were more frequent in group D (P = .012). Group A had higher overall (P < .001) and allogeneic blood transfusion rates (P < .001) compared with the staged groups. Staged procedures within 6-12 months apart vs same-day bilateral THA, older age, Charlson-Deyo index ≥2 vs 0, and earlier vs recent admission year were associated with higher adjusted odds for major complications.
Same-day bilateral THA in a high-volume joint replacement center may be a safe option for younger and healthier patients, given the relatively low incidence of adverse events reported in this study.
双侧髋关节退行性疾病的治疗策略包括同日或分期双侧全髋关节置换术（THA），但关于其疗效的信息仍然稀少。我们试图描述不同时间间隔的同日和分期双侧THA术后的院内并发症及输血率，并评估这些事件的危险因素。
我们回顾性分析了1999年至2014年间3785例接受同日双侧（n = 1946；A组）和分期双侧THA患者的管理数据，分期双侧THA患者按以下间隔分期：（1）间隔0 - 3个月（n = 328；B组）；（2）间隔3 - 6个月（n = 703；C组）；（3）间隔6 - 12个月（n = 808；D组）。我们记录了患者的人口统计学信息、Charlson - Deyo合并症指数以及院内局部和全身（轻微和严重）并发症。比较了各组之间的并发症和输血率。建立了逻辑回归模型以确定严重并发症的危险因素。
局部并发症罕见。A组轻微并发症的发生率较低（P < 0.001）。D组严重并发症的发生率较高（P = 0.012）。与分期手术组相比，A组的总体（P < 0.001）和异体输血率（P < 0.001）更高。间隔6 - 12个月的分期手术与同日双侧THA相比、年龄较大、Charlson - Deyo指数≥2与0相比以及入院年份较早与较近相比，严重并发症的调整后优势比更高。
鉴于本研究报道的不良事件发生率相对较低，在大型关节置换中心，同日双侧THA对于更年轻、更健康的患者可能是一种安全的选择。
