Panchal Sameer, Jogani Abhinav D, Mohanty Shubhranshu S, Rathod Tushar, Kamble Prashant, Keny Swapnil A
Department of Orthopaedics, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, 400008 India.
Department of Orthopaedics, Seth GS Medical College and KEM Hospital, Mumbai, 400012 India.
Indian J Orthop. 2021 Oct 4;55(5):1250-1255. doi: 10.1007/s43465-021-00536-w. eCollection 2021 Oct.
Rationale for symptomatic severe bilateral arthritis of the hip is sequential bilateral THR completed under the same anaesthesia. The rarity of procedures and apprehension of complications preclude the widespread use.
Retrospective analysis of prospectively collected data from 108 patients (216 hips) with bilateral arthritis who underwent total hip arthroplasties was done: out of which 54 patients (108 hips) underwent a single-stage sequential procedure (sequential group) and a matched group of 54 patients (108 hips) underwent a two-stage procedure at different admissions (staged group). Patients were matched according to age (± 2 years), gender, American Society of Anaesthesiologists classification, perioperative management protocol and diagnosis. The mean duration of follow-up for sequential group was 5.1 years while that of staged group was 5.3 years.
Most patients (88.88%) were operated with uncemented implants having ceramic on ceramic bearing surfaces under spinal or general anaesthesia. The operating time, post-op limb length and functional outcomes of both groups were comparable. Although the total estimated blood loss was significantly less in the sequential group (502 ml) as compared to the staged group (570 ml), the mean blood transfusion requirement was significantly higher (1.6 units) in the sequential group as compared to that in the staged group (0.9 units). The mean cumulative length of hospital stay was significantly longer in the staged group (23 days) compared with the sequential group (16 days).
Single-stage bilateral total hip arthroplasty is a safe and viable option when performed with expertise in appropriately selected patients without any surge in complications.
对于有症状的双侧严重髋关节关节炎，采用在同一麻醉下完成双侧全髋关节置换术（THR）的方案。该手术的罕见性以及对并发症的担忧限制了其广泛应用。
对前瞻性收集的108例双侧关节炎患者（216髋）行全髋关节置换术的数据进行回顾性分析：其中54例患者（108髋）接受了单阶段序贯手术（序贯组），另一组匹配的54例患者（108髋）在不同住院期间接受了两阶段手术（分期组）。根据年龄（±2岁）、性别、美国麻醉医师协会分级、围手术期管理方案和诊断对患者进行匹配。序贯组的平均随访时间为5.1年，分期组为5.3年。
大多数患者（88.88%）在脊髓麻醉或全身麻醉下使用非骨水泥型假体，其关节面为陶瓷对陶瓷。两组的手术时间、术后肢体长度和功能结果具有可比性。虽然序贯组的估计总失血量（502 ml）明显少于分期组（570 ml），但序贯组的平均输血需求量（1.6单位）明显高于分期组（0.9单位）。分期组的平均累计住院时间（23天）明显长于序贯组（16天）。
对于经过适当选择的患者，由专业人员进行单阶段双侧全髋关节置换术是一种安全可行的选择，且不会出现并发症激增的情况。
