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. 2020 May;106(3):577-581. doi: 10.1016/j.otsr.2020.02.003. Epub 2020 Apr 4.
One-stage bilateral hip replacement has the advantage of involving a single anesthesia, single hospital admission and single rehabilitation program. The theoretic drawback is increased surgical risk. Few French series have been reported, and none with comparison versus unilateral arthroplasty. We therefore conducted a comparative case-control study between 1-stage bilateral (1B-THA) and unilateral total hip arthroplasty (U-THA), assessing (1) morbidity/mortality, (2) survival, and (3) functional scores and forgotten hip rates.
In a selected ASA 1 or 2 population, 1B-THA shows complications rates and implant survival comparable to U-THA.
Between 2004 and 2018, 327 patients were included: 109 with 1B-THA, 218 with U-THA. One 1B-THA patient was matched to 2 U-THA patients on age, gender, diagnosis, ASA score 1 or 2, and anterior or posterior approach. Minimum follow-up was 12 months. Complications were collected for all patients in both groups. Early (≤90 days) or late (>90 days) morbidity/mortality and implant survival were recorded for both groups. Secondary endpoints concerned blood-sparing strategy and blood loss, functional scores, and patient satisfaction.
Mortality was zero in both groups. There was no significant difference in complications rates (1B-THA 38.5%, U-THA 40.8%) (p=0.69), whether early (8.3% [9/109] and 7.8% [17/218] respectively [p=0.89]) or late (30.3% [33/109] and 33.0% [72/218] respectively [p=0.61]). Limb-length discrepancy was significantly less frequent in 1B-THA (5.5% [6/109] versus 13.3% [29/218] [p=0.03]). Forgotten hip rate was significantly more frequent in 1B-THA (86% [94/109] versus 70% [152/218] [p=0.01]). Five-year Kaplan-Meier implant survival was 97.2% (95% CI [91.9-99.1]) in 1B-THA and 96.6% (95% CI [93.0-98.4]) in U-THA (p=0.08).
One-stage bilateral total hip arthroplasty gave acceptable results in disabling bilateral osteoarthritis of the hip with low surgical risk in selected patients (ASA 1 or 2). Mortality, complications and implant survival were unaffected, but the 1-stage bilateral procedure allowed better control of limb-length and provided a higher rate of forgotten hip.
III, matched case-control study.
一期双侧髋关节置换术的优点在于涉及单次麻醉、单次住院和单次康复计划。理论上的缺点是手术风险增加。法国已经报道了一些系列研究，但没有与单侧关节置换术进行比较的研究。因此，我们进行了一期双侧（1B-THA）和单侧全髋关节置换术（U-THA）之间的病例对照研究，评估了（1）发病率/死亡率，（2）生存率，以及（3）功能评分和遗忘髋率。
在选择的 ASA 1 或 2 人群中，1B-THA 的并发症发生率和植入物生存率与 U-THA 相当。
2004 年至 2018 年间，共纳入 327 例患者：109 例行 1B-THA，218 例行 U-THA。1B-THA 患者按年龄、性别、诊断、ASA 评分 1 或 2、前侧或后侧入路与 2 例 U-THA 患者进行匹配。最小随访时间为 12 个月。收集两组所有患者的并发症。记录两组患者的早期（≤90 天）或晚期（>90 天）发病率/死亡率和植入物生存率。次要终点包括血液节约策略和失血量、功能评分和患者满意度。
两组死亡率均为零。并发症发生率无显著差异（1B-THA 38.5%，U-THA 40.8%）（p=0.69），无论是早期（8.3% [9/109]和 7.8% [17/218]）还是晚期（30.3% [33/109]和 33.0% [72/218]）（p=0.89）。1B-THA 的肢体长度差异明显较小（5.5% [6/109]与 13.3% [29/218]）（p=0.03）。1B-THA 遗忘髋率明显较高（86% [94/109]与 70% [152/218]）（p=0.01）。1B-THA 的 5 年 Kaplan-Meier 植入物生存率为 97.2%（95%CI [91.9-99.1]），U-THA 为 96.6%（95%CI [93.0-98.4]）（p=0.08）。
一期双侧全髋关节置换术在选择的（ASA 1 或 2）患者中，为患有双侧髋关节骨关节炎的致残性患者提供了可接受的结果，手术风险较低。死亡率、并发症和植入物生存率不受影响，但一期双侧手术可以更好地控制肢体长度，并提供更高的遗忘髋率。
III 级，匹配病例对照研究。
