Katedra i Klinika Ortopedii Traumatologii i Onkologii Narządu Ruchu PUM, Szczecin, Polska / Department of Orthopedics, Traumatology and Musculoskeletal Oncology, PMU, Szczecin, Poland.
Szpital Wojewódzki w Koszalinie, Polska / Regional Hospital in Koszalin, Poland.
Ortop Traumatol Rehabil. 2020 Feb 29;22(1):17-24. doi: 10.5604/01.3001.0013.9780.
Advanced degenerative hip joint disease is bilateral in approximately 20% of cases, prompting questions of whether it is necessary to perform two separate surgical procedures, whether simultaneous bilateral hip replacement makes the surgical treatment too extensive, and whether it significantly affects the postoperative course.
The study analysed the duration of hospitalisation, perioperative complications, and the need for blood transfusion in 30 patients (27 men and 3 women) with bilateral hip osteoarthritis who underwent simultaneous bilateral total hip replacement from a minimally invasive direct anterior approach followed by a fast track protocol for optimisation of perioperative management between 2014 and 2017. The mean age of patients was 60.2 years (range 43 to 77 years) and the mean follow-up period was 28 months (range 18 to 48 months).
Mean duration of hospitalisation was 4.5 days (range 3 to 9 days). A total of 4 patients (13%) required allogeneic blood transfusion. No patient developed thromboembolic or infectious complications or implant dislocation after surgery. Apart from one case where the acetabulum was not selected correctly, which resulted in postoperative loosening, there were no other significant medical events potentially related to the surgical treatment.
Simultaneous bilateral total hip arthroplasty using a minimally invasive direct approach and a fast track protocol for optimisation of perioperative management does not increase the need for perioperative blood transfusion or the number of surgical complications and constitutes a safe, effective, and recommendable method of treatment in patients with advanced bilateral degenerative disease of the hip joints.
大约 20%的病例存在双侧进展性退行性髋关节疾病，这引发了一些疑问，即是否需要进行两次单独的手术，同期双侧全髋关节置换术是否使手术治疗范围过大，以及是否会显著影响术后过程。
本研究分析了 2014 年至 2017 年间，30 例双侧髋关节骨关节炎患者（27 名男性和 3 名女性）采用微创直接前入路同期双侧全髋关节置换术，随后采用快速康复方案优化围手术期管理，患者的住院时间、围手术期并发症和输血需求。患者的平均年龄为 60.2 岁（范围 43 至 77 岁），平均随访时间为 28 个月（范围 18 至 48 个月）。
平均住院时间为 4.5 天（范围 3 至 9 天）。共有 4 名患者（13%）需要异体输血。术后无血栓栓塞或感染并发症或假体脱位。除 1 例髋臼选择不当导致术后松动外，无其他与手术治疗相关的重大医疗事件。
微创直接入路同期双侧全髋关节置换术结合快速康复方案优化围手术期管理，不会增加围手术期输血需求或手术并发症的数量，是治疗髋关节退行性疾病晚期双侧患者的一种安全、有效且值得推荐的方法。
