Service de Chirurgie Orthopédique et Chirurgie du Sport, Institut Universitaire Locomoteur et du Sport (IULS) - Hôpital Pasteur 2, 30, voie Romaine, 06000 Nice, France.
Service d'Anesthésie-réanimation, Institut Arnault Tzanck, 171, rue du Commandant Gaston-Cahuzac, 06700 Saint-Laurent-du-Var, France.
Orthop Traumatol Surg Res. 2019 Nov;105(7):1265-1270. doi: 10.1016/j.otsr.2019.07.016. Epub 2019 Oct 4.
Advantages of performing bilateral total hip arthroplasty (THA) in one stage include a single hospital stay, a single exposure to anaesthesia risks, and expedited rehabilitation. Controversy persists however, regarding safety, notably morbidity and mortality rates. Importantly, few studies have compared the anterior to the posterior approach for single-stage bilateral THA (1B-THA). The objective of this retrospective study in a uniform patient population was to compare the anterior and posterior approaches for 1B-THA in terms of: 1) early mortality rates, 2) early complications, 3) and 90-day re-admission rates, hospital stay lengths, and blood loss.
1B-THA in patients younger than 80 years who have an ASA score of 1 or 2 is associated with no early mortality and with low early morbidity rates regardless of whether the anterior or posterior approach is used.
A single-centre retrospective comparative design was used to assess 90-day mortality and morbidity rates in consecutive patients who underwent 1B-THA between 2004 and 2018. The groups managed with the anterior approach (AA) without traction table and posterior approach (PA) were compared. The ASA score was ≤2 and age ≤80 years in all patients. The groups were comparable for age, sex distribution, ASA score, pre-operative haemoglobin level, and reason for THA.
We included 55 patients managed via the AA and 82 managed via the PA. No patients died in either group. Early complications occurred in 3 patients in the AA group and 6 in the AP group (p=0.74). No differences were noted between the two groups for each type of complication. In the AA group, 3 patients experienced major complications (p=0.06) (2 cerebrovascular events and 1 peri-prosthetic fracture). In the PA group, 6 patients experienced minor complications (1 case each of dislocation, piriformis syndrome, sacral pressure sore, and deep vein thrombosis and 2 cases of ilio-psoas irritation; p=0.08). Operative time was 144minutes (range, 110-195minutes) in the AA group and 171minutes (range, 108-255minutes) in the PA group (p<0.001). Mean hospital stay length was 7.6 days (range, 3-13 days) overall, 6.7 days (range, 5-11 days) in the AA group, and 8.2 days (range, 3-13 days) in the PA group (p<0.001). The early re-admission rate was 2.9% overall, with no difference between the AA group (3.6% [2/55]) and the PA group (2.4% [2/82]) A post-operative blood transfusion was required by 34/137 (24.8%) patients overall, 15/55(27.3%) patients in the AA group and 19/82 (23.2%) patients in the PA group (p=0.58).
In selected patients (ASA score 1 or 2 and age ≤80 years), 1B-THA was not followed by any early deaths in the patients managed using the anterior or posterior approach. Total early morbidity rates were low. Neither the types of complications nor the early re-admission rates differed between the AA and PA groups. The shorter operative time in the AA group is ascribable to change in patient installation between the two arthroplasties when the PA is used.
III, comparative study of consecutive patients.
同期双侧全髋关节置换术（THA）的优点包括单次住院、单次麻醉风险暴露和加速康复。然而，关于安全性，尤其是发病率和死亡率，仍存在争议。重要的是，很少有研究比较过前侧入路和后侧入路用于同期双侧 THA（1B-THA）。本研究在统一的患者人群中进行回顾性研究，旨在比较前侧和后侧入路在以下方面的差异：1）早期死亡率、2）早期并发症和 3）90 天再入院率、住院时间和失血量。
年龄在 80 岁以下且 ASA 评分为 1 或 2 的患者行同期双侧 THA 与无早期死亡率相关，且早期发病率较低，无论使用前侧或后侧入路。
采用单中心回顾性对比设计，评估 2004 年至 2018 年间连续行 1B-THA 的患者 90 天的死亡率和发病率。比较了无牵引台的前侧入路（AA）组和后侧入路（PA）组。所有患者的 ASA 评分均为≤2，年龄均≤80 岁。两组在年龄、性别分布、ASA 评分、术前血红蛋白水平和 THA 原因方面具有可比性。
我们纳入了 55 例行 AA 治疗的患者和 82 例行 PA 治疗的患者。两组均无患者死亡。AA 组有 3 例患者发生早期并发症，PA 组有 6 例患者发生早期并发症（p=0.74）。两组之间每种并发症的发生率无差异。在 AA 组中，3 例患者发生严重并发症（p=0.06）（2 例为脑血管事件，1 例为假体周围骨折）。在 PA 组中，6 例患者发生轻微并发症（1 例脱位，1 例梨状肌综合征，1 例骶部压疮，1 例深静脉血栓形成，2 例髂腰肌刺激；p=0.08）。AA 组的手术时间为 144 分钟（范围 110-195 分钟），PA 组为 171 分钟（范围 108-255 分钟）（p<0.001）。平均住院时间为 7.6 天（范围 3-13 天），AA 组为 6.7 天（范围 5-11 天），PA 组为 8.2 天（范围 3-13 天）（p<0.001）。早期再入院率为 2.9%，AA 组（3.6%[2/55]）和 PA 组（2.4%[2/82]）之间无差异。34/137（24.8%）患者需要术后输血，AA 组 15/55（27.3%），PA 组 19/82（23.2%）（p=0.58）。
在选择的患者（ASA 评分 1 或 2 且年龄≤80 岁）中，使用前侧或后侧入路的患者均未出现早期死亡。总早期发病率较低。AA 组和 PA 组之间，并发症类型和早期再入院率均无差异。AA 组手术时间较短，原因是在使用 PA 时，两个髋关节置换术之间改变了患者的安装方式。
III，连续患者的比较研究。
