Department of Orthopedic Surgery, Yamaguchi Prefectural Grand Medical Center, Hofu, Japan.
Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Ube, Japan.
J Orthop Surg (Hong Kong). 2023 May-Aug;31(2):10225536231180328. doi: 10.1177/10225536231180328.
It remains unclear whether simultaneous bilateral total hip arthroplasty (SimBTHA) or staged bilateral total hip arthroplasty (StaBTHA) is clinically superior. No study has compared these two procedures matching surgical approach and patient background. This study aimed to clarify the differences between SimBTHA using direct anterior approach (SimBTHA-DAA) and StaBTHA using the direct anterior approach (StaBTHA-DAA).
Patients who underwent THA between 2012 and 2020 were enrolled, resulting in a total of 1658 hips of 1388 patients. After propensity score matching for patient background, 204 hips of 102 patients (51 patients in each group) were examined. Clinical and radiographic outcomes, complications, intraoperative blood loss and blood transfusions (BT) were evaluated. In complications, we evaluated periprosthetic fractures, pulmonary embolism, deep venous thrombosis, surgical site infection and dislocation.
At the final follow-up, clinical and radiographic outcomes and complications were not significantly different between the groups. Intraoperative blood loss was equivalent for SimBTHA and the sum in the first- and second-stage StaBTHA. The total-BT rate was significantly higher for SimBTHA-DAA than for StaBTHA-DAA ( < .0001). The allogeneic BT rate was significantly higher in SimBTHA-DAA in the supine position (32.3%) than in StaBTHA-DAA (8.3%) ( = .007). However, no patient who received autologous BT required allogeneic BT.
Clinical and radiographic outcomes were equivalent between SimBTHA-DAA and StaBTHA-DAA. The allogeneic BT rate was significantly higher in SimBTHA-DAA than in StaBTHA-DAA. Autologous BT reduced the use of allogeneic BT in SimBTHA-DAA. Auto-BT may be useful for avoiding allo-BT in SimBTHA.
目前尚不清楚同期双侧全髋关节置换术（SimBTHA）与分期双侧全髋关节置换术（StaBTHA）在临床上孰优孰劣。没有研究比较过这两种手术方法，也没有比较过手术入路和患者背景。本研究旨在明确直接前侧入路同期双侧全髋关节置换术（SimBTHA-DAA）与直接前侧入路分期双侧全髋关节置换术（StaBTHA-DAA）之间的差异。
纳入 2012 年至 2020 年间接受全髋关节置换术的患者，共纳入 1388 例患者的 1658 髋。对患者背景进行倾向评分匹配后，共纳入 102 例患者的 204 髋（每组 51 例）。评估临床和影像学结果、并发症、术中失血量和输血（BT）情况。并发症包括假体周围骨折、肺栓塞、深静脉血栓形成、手术部位感染和脱位。
最终随访时，两组患者的临床和影像学结果及并发症均无显著差异。SimBTHA 的术中失血量与第一期和第二期 StaBTHA 的总失血量相当。SimBTHA-DAA 的总 BT 率明显高于 StaBTHA-DAA（<0.0001）。SimBTHA-DAA 中仰卧位的同种异体 BT 率（32.3%）明显高于 StaBTHA-DAA（8.3%）（=0.007）。然而，接受同种异体 BT 的患者均无需接受异体 BT。
SimBTHA-DAA 与 StaBTHA-DAA 的临床和影像学结果相当。SimBTHA-DAA 的同种异体 BT 率明显高于 StaBTHA-DAA。SimBTHA-DAA 中自体 BT 可减少同种异体 BT 的使用。自体 BT 可能有助于避免 SimBTHA 中使用异体 BT。
