School of Medicine, Pharmacy and Health, Durham University, Stockton, United Kingdom; Trauma and Orthopaedics, Northumbria Healthcare NHS Foundation Trust, Northumberland, United Kingdom.
Princess Elizabeth Orthopaedic Centre, Royal Devon & Exeter NHS Foundation Trust, Exeter, United Kingdom.
J Arthroplasty. 2020 Jan;35(1):166-171. doi: 10.1016/j.arth.2019.08.022. Epub 2019 Aug 14.
Simultaneous bilateral total hip arthroplasty (SimBTHA) is often performed in younger, fitter patients with bilateral hip disease. If patients are deemed not suitable for SimBTHA due to concurrent comorbidity, it may be more appropriate to perform staged bilateral total hip arthroplasties (StBTHAs) 3-6 months apart to minimize complications and morbidity. Complication rates following hip arthroplasty are low and large national datasets are helpful for assessing these rare events. We aimed at comparing SimBTHA vs StBTHA in order to determine any differences in morbidity and mortality.
Hospital Episode Statistics data for all patients who underwent bilateral THAs in the English National Health Service between April 2005 and July 2014 were obtained. Patients were grouped into SimBTHAs (same day) or staged, with the second THA occurring between 3 and 6 months after the first. Medical and surgical complications were compared and total length of stay was assessed.
A total of 2507 underwent SimBTHAs and 9915 had StBTHAs. SimBTHA patients were significantly younger (60.6 vs 65.5 years, P < .001) and more likely to be male, but had similar Charlson comorbidity scores. Compared to StBTHAs, patients undergoing SimBTHAs had a greater risk of pulmonary embolism, myocardial infarction, renal failure, chest infection, and inhospital death. Patients undergoing SimBTHAs had a significantly shorter overall hospital stay (8.9 vs 10.4 days). Patients undergoing SimBTHA at high-volume units had a lower average Charlson score and subsequent complication rate than low-volume units.
These findings highlight the greater risks of SimBTHA in patients with Charlson score greater than 0 performed at lower-volume centers in England.
双侧全髋关节置换术（SimBTHA）常用于患有双侧髋关节疾病的年轻、健康的患者。如果由于合并症患者不适合进行 SimBTHA，则可能更适合相隔 3-6 个月分期进行双侧全髋关节置换术（StBTHA），以最大限度地减少并发症和发病率。髋关节置换术后的并发症发生率较低，大型国家数据集有助于评估这些罕见事件。我们旨在比较 SimBTHA 与 StBTHA，以确定发病率和死亡率是否存在差异。
获取了 2005 年 4 月至 2014 年 7 月期间在英国国家卫生服务系统中接受双侧 THA 的所有患者的医院病例统计数据。将患者分为 SimBTHA（同一天）或分期，第二次 THA 在第一次手术后 3-6 个月进行。比较了医疗和手术并发症，并评估了总住院时间。
共有 2507 例患者接受了 SimBTHA，9915 例患者接受了 StBTHA。SimBTHA 患者明显更年轻（60.6 岁对 65.5 岁，P<0.001），且更可能为男性，但 Charlson 合并症评分相似。与 StBTHA 相比，SimBTHA 患者发生肺栓塞、心肌梗死、肾衰竭、胸部感染和院内死亡的风险更高。SimBTHA 患者的总住院时间明显更短（8.9 天对 10.4 天）。在高容量单位接受 SimBTHA 的患者的平均 Charlson 评分和随后的并发症发生率低于低容量单位。
这些发现强调了在英国低容量中心接受 Charlson 评分大于 0 的患者进行 SimBTHA 的风险更高。
