Torres-Ramirez Ricardo J, Pagan Cale, Rodriguez Samuel, Oettl Felix, Gonzalez Della Valle Alejandro, Rodriguez Jose A
Adult Reconstruction and Joint Replacement Department, Hospital for Special Surgery, New York, New York.
J Arthroplasty. 2025 Feb;40(2):455-459. doi: 10.1016/j.arth.2024.08.032. Epub 2024 Aug 24.
Bilateral hip osteoarthritis is evident in approximately 20% of patients who present to the clinic for evaluation of hip pain, and for those undergoing total hip arthroplasty (THA), 22% will end up needing a contralateral THA. The risk and benefits of simultaneous bilateral total hip arthroplasty (SBTHA) versus staged bilateral THA procedures have been well studied, demonstrating equivalent safety profiles comparable to unilateral and SBTHA. However, the influence of the surgical approach on SBTHA on postoperative outcomes remains unclear. We sought to compare perioperative outcomes and complication rates between the direct anterior approach (DAA) and posterior approach (PA) in patients undergoing SBTHA.
We performed a 1:1 propensity score match based on age, sex, and body mass index. A total of 252 patients were available after matching, 126 patients in the DAA group and 126 in the PA group. Perioperative outcomes as well as surgical complications at the latest follow-up were retrospectively collected for each group. The mean follow-up was 36.7 months (range, 12.5 to 74.4).
A SBTHA with DAA had significantly shorter surgical time (P < 0.001), anesthesia time (P < 0.001), and length of stay (P < 0.001), compared to the PA. A greater percentage of patients in the DAA group (91%) were discharged home compared to the PA group (57%) (P < 0.001). There were no differences in in-hospital complications (P = 0.617), 90-day complications (P = 0.605), or reoperation rates (P = 0.309) between surgical approaches.
A SBTHA, either through the DAA or PA, can be safely performed with low complication rates. The DAA in the setting of SBTHA provides shorter surgical times, a shorter length of stay, and a greater percentage of patients discharged home.
在因髋关节疼痛到诊所就诊的患者中，约20%存在双侧髋关节骨关节炎，而在接受全髋关节置换术（THA）的患者中，22%最终需要对侧THA。同期双侧全髋关节置换术（SBTHA）与分期双侧THA手术的风险和益处已得到充分研究，显示出与单侧和SBTHA相当的安全性。然而，手术入路对SBTHA术后结果的影响仍不清楚。我们试图比较接受SBTHA的患者采用直接前路入路（DAA）和后路入路（PA）的围手术期结果和并发症发生率。
我们根据年龄、性别和体重指数进行1:1倾向评分匹配。匹配后共有252例患者，DAA组126例，PA组126例。回顾性收集每组的围手术期结果以及最新随访时的手术并发症。平均随访时间为36.7个月（范围12.5至74.4个月）。
与PA相比，采用DAA进行SBTHA的手术时间（P < 0.001）、麻醉时间（P < 0.001）和住院时间（P < 0.001）明显更短。与PA组（57%）相比，DAA组更高比例的患者（91%）出院回家（P < 0.001）。不同手术入路之间住院并发症（P = 0.617）、90天并发症（P = 0.605）或再次手术率（P = 0.309）无差异。
通过DAA或PA进行SBTHA均可安全实施，并发症发生率低。在SBTHA中，DAA可缩短手术时间、缩短住院时间，并使出院回家的患者比例更高。
