Koutserimpas Christos, Rob Edouard, Servien Elvire, Lustig Sébastien, Batailler Cécile
Orthopaedic Surgery and Sports Medicine Department, Croix-Rousse Hospital, University Hospital, 69004 Lyon, France.
Orthopaedic Surgery and Sports Medicine Department, Croix-Rousse Hospital, University Hospital, 69004 Lyon, France - LIBM - EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University, 69100 Lyon, France.
SICOT J. 2024;10:31. doi: 10.1051/sicotj/2024028. Epub 2024 Aug 22.
Simultaneous bilateral total hip arthroplasty (THA) has demonstrated similar clinical outcomes to staged bilateral THA. However, there is scarce data regarding the early postoperative complications. This study compares simultaneous to staged bilateral THA with the direct anterior approach (DAA) regarding early complications and revision surgeries.
This retrospective case-control study included all bilateral THAs, performed by DAA between 2013 and 2021 with a minimum follow-up of 6 months. A total of 264 THAs (132 patients) were identified [simultaneous group (1T): 58 patients; staged group (2T): 74] with a mean follow-up of 54 months. Complications and revisions, clinical outcomes, and days off work were assessed at the last follow-up. Moreover, blood loss was evaluated by the modified method of Mercuriali and Inghilleri.
Blood loss was higher in the 1T group (1003 mL 1T vs. 740 mL 2T; p < 0.001) but there was no significant difference in transfusion rates (5% 1T vs. 3% 2T; p = 0.4). There were no complications in 1T, while the complication rate was 5.2% (n = 6) in 2T (p = 0.012). There were 5 revisions in the 2T group, including 2 debridements with polyethylene exchange and implant retention for early infections, 2 revisions for aseptic loosening in the same patient, and 1 revision due to fracture. Postoperative pain on D3 was equivalent in both groups (4.2 1T vs. 4.3 2T; p = 0.79). The improvement in function according to the HHS at 2 months was better in the 1T group, but not significant (36.8 1T vs. 32.9 2T; p = 0.05). The total number of days off work was significantly higher in the 2T group (82.6 days vs. 178.8; p = 0.025).
Simultaneous bilateral THA with the DAA seems to be a safe procedure, with no risk of increased early postoperative complications when compared to the staged procedure with similar functional outcomes and significantly fewer complications and days off work.
同期双侧全髋关节置换术（THA）已显示出与分期双侧THA相似的临床结果。然而，关于术后早期并发症的数据很少。本研究比较了采用直接前路（DAA）的同期与分期双侧THA在早期并发症和翻修手术方面的情况。
这项回顾性病例对照研究纳入了2013年至2021年期间由DAA进行的所有双侧THA，随访时间至少为6个月。共确定了264例THA（132例患者）[同期组（1T）：58例患者；分期组（2T）：74例]，平均随访54个月。在最后一次随访时评估并发症和翻修情况、临床结果以及误工天数。此外，采用Mercuriali和Inghilleri的改良方法评估失血量。
1T组的失血量更高（1T组为1003 mL，2T组为740 mL；p < 0.001），但输血率无显著差异（1T组为5%，2T组为3%；p = 0.4）。1T组无并发症，而2T组的并发症发生率为5.2%（n = 6）（p = 0.012）。2T组有5例翻修，包括2例因早期感染进行的清创并更换聚乙烯和保留植入物、同一患者的无菌性松动翻修2例以及骨折翻修1例。两组术后第3天的疼痛程度相当（1T组为4.2，2T组为4.3；p = 0.79）。1T组在2个月时根据髋关节 Harris 评分（HHS）的功能改善情况更好，但差异不显著（1T组为36.8，2T组为32.9；p = 0.05）。2T组的总误工天数显著更高（82.6天对178.8天；p = 0.025）。
采用DAA的同期双侧THA似乎是一种安全的手术方法，与分期手术相比，术后早期并发症增加的风险较低，功能结果相似，并发症和误工天数显著减少。
