Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois.
J Arthroplasty. 2023 Jul;38(7 Suppl 2):S314-S318. doi: 10.1016/j.arth.2022.12.024. Epub 2022 Dec 16.
The ideal timing for bilateral total hip arthroplasty (THA) remains controversial. This study compared 90-day outcomes after simultaneous bilateral THA and contralateral surgery in staged bilateral THA to a matched cohort of unilateral procedures.
Patients undergoing primary, elective THA during 2015 to 2020 were reviewed in a national database. Of the 273,281 patients identified, 39,905 (14.6%) were bilateral. Patients were divided into cohorts of unilateral THA, simultaneous bilateral THA, and staged bilateral THA at 1 to 14 days, 15 to 42 days, 43 to 90 days, and 91 to 365 days. Bilateral THA cohorts were matched with unilateral THA patients based on demographics and comorbidities. Ninety-day outcomes after the second THA were compared between matched groups.
Simultaneous bilateral THA resulted in higher rates of transfusion (odds ratio [OR] 4.43, 95% confidence interval 2.31-2.63, P < .001), readmission (OR 2.60, 2.01-3.39, P < .001), and any complication (OR 1.86, 1.55-2.24, P < .001) compared to unilateral THA. Contralateral THA staged at 1 to 14 days increased the risk of readmission (OR 1.83, 1.49-2.24, P < .001) and any complication (OR 1.45, 1.26-1.66, P < .001) relative to unilateral THA. Contralateral THA staged at 15 to 42 days increased the risk of periprosthetic joint infection (OR 3.15, 1.98-5.19, P < .001), readmission (OR 1.92, 1.55-2.39, P < .001), and any complication (OR 1.70, 1.46-1.97, P < .001). Contralateral THA staged beyond 42 days resulted in similar or decreased rates of adverse events relative to unilateral THA.
Bilateral THA should be staged a minimum of 6 weeks apart in appropriately selected patients to avoid an increased risk of adverse events after the second THA compared to unilateral THA.
双侧全髋关节置换术（THA）的理想时机仍存在争议。本研究比较了同期双侧 THA 和分期双侧 THA 中对侧手术与单侧手术 90 天的结果，并与单侧手术进行了匹配。
对 2015 年至 2020 年期间接受初次、择期 THA 的患者进行了全国数据库回顾。在确定的 273281 例患者中，39905 例（14.6%）为双侧。患者分为单侧 THA、同期双侧 THA 和分期双侧 THA 队列，间隔 1-14 天、15-42 天、43-90 天和 91-365 天。同期双侧 THA 队列根据人口统计学和合并症与单侧 THA 患者进行匹配。比较匹配组之间第二次 THA 后 90 天的结果。
同期双侧 THA 导致输血（比值比 [OR] 4.43，95%置信区间 2.31-2.63，P<.001）、再入院（OR 2.60，2.01-3.39，P<.001）和任何并发症（OR 1.86，1.55-2.24，P<.001）的发生率高于单侧 THA。间隔 1-14 天进行对侧 THA 分期增加了再入院（OR 1.83，1.49-2.24，P<.001）和任何并发症（OR 1.45，1.26-1.66，P<.001）的风险。间隔 15-42 天进行对侧 THA 分期增加了假体周围关节感染（OR 3.15，1.98-5.19，P<.001）、再入院（OR 1.92，1.55-2.39，P<.001）和任何并发症（OR 1.70，1.46-1.97，P<.001）的风险。间隔超过 42 天进行对侧 THA 分期与单侧 THA 相比，不良事件的发生率相似或降低。
双侧 THA 应至少间隔 6 周分期进行，以避免与单侧 THA 相比，第二次 THA 后不良事件的风险增加。
