University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstr. 74, 01307, Dresden, Germany.
German Arthroplasty Registry (EPRD), Berlin, Germany.
BMC Musculoskelet Disord. 2024 Aug 2;25(1):617. doi: 10.1186/s12891-024-07693-7.
The burden of osteoarthritis (OA) in multiple joints is high and for patients with bilateral OA of the hip there is no clear recommendation about the indication for simultaneous (one-stage) bilateral total hip arthroplasty (THA) versus two-staged procedures. The purpose of this study was therefore to compare revision and mortality rates after different strategies of surgical timing in bilateral hip OA from the German Arthroplasty Registry (EPRD).
Since 2012 22,500 patients with bilateral THA (including 767 patients with one-staged bilateral surgery and 11,796 patients with another separate procedures within one year after first THA) are documented in the registry. The patients who underwent simultaneous bilateral THA were matched with a cohort of 767 patients who underwent the second THA between 1 and 90 days postoperatively (short interval) and another cohort of 4,602 patients with THA between 91 and 365 days postoperatively (intermediate interval). Revision for all reasons and mortality rates were recorded. Cox regression was performed to evaluate the influence of different patient characteristics.
The cumulative 5-year revision rate for patients with simultaneous bilateral THA was 1.8% (95% CI 0.9-2.6), for patients with two-staged THA 2.3% (95% CI 1.0-3.6) in the short interval and 2.5% (95% CI 2.1-2.9) in the intermediate interval, respectively. In all three groups, patients who underwent THA in a high-volume center (≥ 500 THA per year) had a significant lower risk for revision (HR 0.687; 95% CI 0.501-0.942) compared to surgeries in a low-volume center (< 250 THA per year). There was no significant difference regarding cumulative mortality rates in the three cohorts. Higher age (HR 1.060; 95% CI 1.042-1.078) and severe comorbidities as reflected in the Elixhauser Score (HR 1.046; 95% CI 1.014-1.079) were associated with higher mortality rates after simultaneous THA.
Simultaneous bilateral THA seems to be a safe procedure for younger patients with limited comorbidities who have bilateral end-stage hip OA, especially if performed in high-volume centers.
III.
骨关节炎（OA）在多个关节中的负担很高，对于双侧髋关节 OA 的患者，对于同期（一期）双侧全髋关节置换术（THA）与分期手术的适应证尚无明确建议。因此，本研究的目的是比较德国关节置换登记处（EPRD）中双侧髋关节 OA 不同手术时机策略后的翻修和死亡率。
自 2012 年以来，已有 22500 例双侧 THA 患者（包括 767 例同期双侧手术患者和 11796 例初次 THA 后 1 年内再次接受手术的患者）在该登记处进行了登记。同期双侧 THA 患者与术后 1 至 90 天（短间隔）接受第 2 次 THA 的 767 例患者队列和术后 91 至 365 天（中间隔）接受 4602 例 THA 的患者队列相匹配。记录所有原因的翻修率和死亡率。采用 Cox 回归评估不同患者特征的影响。
同期双侧 THA 患者的 5 年累积翻修率为 1.8%（95%CI 0.9-2.6），分期双侧 THA 患者在短间隔和中间隔的翻修率分别为 2.3%（95%CI 1.0-3.6）和 2.5%（95%CI 2.1-2.9）。在所有三组中，在高容量中心（≥500 例/年）进行 THA 的患者与在低容量中心（<250 例/年）进行手术的患者相比，翻修风险显著降低（HR 0.687；95%CI 0.501-0.942）。三组患者的累积死亡率无显著差异。年龄较高（HR 1.060；95%CI 1.042-1.078）和 Elixhauser 评分反映的严重合并症（HR 1.046；95%CI 1.014-1.079）与同期 THA 后死亡率较高相关。
对于患有双侧终末期髋关节 OA、合并症有限的年轻患者，同期双侧 THA 似乎是一种安全的手术方法，尤其是在高容量中心进行时。
III。
