Centre for Musculoskeletal Surgery, Charité-University Hospital Berlin, Charitéplatz 1, 10117, Berlin, Germany.
OCM Orthopädische Chirurgie München, Steinerstraße 6, 81369, Munich, Germany.
Int Orthop. 2023 Oct;47(10):2571-2578. doi: 10.1007/s00264-023-05871-1. Epub 2023 Jun 24.
The aim of this study was to compare early outcomes after simultaneous and staged hip arthroplasty (THA) in patients with bilateral symptomatic pathology.
We conducted a retrospective cohort study including all patients scheduled for primary THA for bilateral hip osteoarthritis (OA, n = 290). Patients either received simultaneous (n = 152, 52.4%) or staged (n = 138, 47.6%) bilateral THA based on individual preference. All operations (n = 428) were performed by one single, high-volume surgeon. Demographic data (e.g., age, ASA score) as well as perioperative parameters (haemoglobin drop (Hb), red blood cell transfusion, length of stay (LOS), operation time, six week complication rate and achievement of inpatient rehabilitation key points) were evaluated.
Patients in the simultaneous bilateral THA group were younger (62.8 ± 8.9 vs. 65 ± 9.7 years, p = 0.022) and had lower ASA scores (1.8, (34.2% ASA 1, 55.3% ASA 2, 37.2% ASA 3) vs. 2.0 (18.8% ASA 1, 61.6% ASA 2, 19.6% ASA 3)) than the staged group. While the average LOS was 7.1 ± 1.7 days for simultaneous bilateral THA, the combined LOS for the staged group was 12.9 ± 2.4 days (p < 0.001). The cumulative operation time in the simultaneous bilateral THA group was 61.1 ± 11.5 min and 57.6 ± 7.3 min in the staged group (p < 0.015). Cumulative Hb loss was significantly higher in the staged group (2.1 ± 7.2 g/dl vs. 3.7 ± 1.3 g/dl, p < 0.001). No significant differences were found concerning the complication rate or early inpatient rehabilitation.
Simultaneous bilateral hip arthroplasty in patients with symptomatic bilateral hip osteoarthritis is as safe and successful as a staged procedure if performed by a high-volume surgeon.
本研究旨在比较双侧症状性病变患者同期和分期髋关节置换术（THA）的早期结果。
我们进行了一项回顾性队列研究，纳入了所有因双侧髋骨关节炎（OA）接受初次 THA 的患者（n=290）。根据个人偏好，患者接受同期（n=152，52.4%）或分期（n=138，47.6%）双侧 THA。所有手术（n=428）均由一位高容量的外科医生完成。评估了人口统计学数据（例如年龄、ASA 评分）以及围手术期参数（血红蛋白下降（Hb）、红细胞输血、住院时间（LOS）、手术时间、六周并发症发生率和住院康复要点的实现）。
同期双侧 THA 组的患者更年轻（62.8±8.9 岁 vs. 65±9.7 岁，p=0.022）且 ASA 评分较低（1.8，（34.2%ASA1，55.3%ASA2，37.2%ASA3）vs. 2.0（18.8%ASA1，61.6%ASA2，19.6%ASA3））。同期双侧 THA 的平均 LOS 为 7.1±1.7 天，分期组的合并 LOS 为 12.9±2.4 天（p<0.001）。同期双侧 THA 组的累计手术时间为 61.1±11.5 分钟，分期组为 57.6±7.3 分钟（p<0.015）。分期组的累计 Hb 丢失量明显更高（2.1±7.2 g/dl vs. 3.7±1.3 g/dl，p<0.001）。两组的并发症发生率或早期住院康复无显著差异。
如果由高容量外科医生进行手术，同期双侧髋关节置换术在治疗有症状的双侧髋骨关节炎患者时与分期手术一样安全且有效。
