Onoi Yuma, Hayashi Shinya, Kuroda Yuichi, Kamenaga Tomoyuki, Tsubosaka Masanori, Nakano Naoki, Kuroda Ryosuke, Matsumoto Tomoyuki
Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
Arch Orthop Trauma Surg. 2024 Dec 12;145(1):12. doi: 10.1007/s00402-024-05703-w.
The purpose of this study was to compare leg length discrepancies (LLD) between simultaneous and staged bilateral total hip arthroplasty (BTHA).
This retrospective cohort study included 150 consecutive patients who underwent BTHA (60 simultaneous and 90 staged BTHA). To adjust for preoperative patient characteristics between groups, 1:1 propensity score matching was performed based on age, sex, body mass index, American Society of Anesthesiologists Physical Status, Tönnis classification, Crowe classification, preoperative range of motion (flexion and abduction), LLD, and Harris Hip Score (HHS). Finally, 66 patients (33 pairs) with comparable preoperative backgrounds were analyzed. Postoperative LLD and clinical outcomes, including HHS, range of motion (flexion and abduction), operative time, intraoperative blood loss, and complications, were compared between the simultaneous and staged BTHA groups.
The LLD in the simultaneous BTHA group was significantly smaller than that in the staged BTHA group (simultaneous BTHA, 3.5 ± 3.2 mm; staged BTHA, 6.2 ± 4.5 mm, p < 0.001). The rate of LLD ≤ 7 mm was significantly higher in simultaneous BTHA (84.8%) compared to staged BTHA (57.6%) (p = 0.028). Other outcomes, including the HHS, range of motion (flexion and abduction), operative time, intraoperative blood loss, and complication rates were similar between the groups.
Simultaneous BTHA has the potential to provide smaller LLD than staged BTHA because simultaneous surgery enables intraoperative comparison of bilateral leg lengths based on both extra- and intra-articular measurements. This approach may be advantageous for postoperative patient satisfaction.
本研究的目的是比较同期双侧全髋关节置换术（BTHA）和分期双侧全髋关节置换术之间的下肢长度差异（LLD）。
这项回顾性队列研究纳入了150例连续接受BTHA的患者（60例同期BTHA和90例分期BTHA）。为了调整组间术前患者特征，基于年龄、性别、体重指数、美国麻醉医师协会身体状况分级、托尼斯分类、克劳分类、术前活动范围（屈曲和外展）、LLD和Harris髋关节评分（HHS）进行1:1倾向评分匹配。最终，分析了66例（33对）术前背景相当的患者。比较同期和分期BTHA组的术后LLD和临床结果，包括HHS、活动范围（屈曲和外展）、手术时间、术中失血和并发症。
同期BTHA组的LLD明显小于分期BTHA组（同期BTHA，3.5±3.2mm；分期BTHA，6.2±4.5mm，p<0.001）。同期BTHA组LLD≤7mm的发生率（84.8%）明显高于分期BTHA组（57.6%）（p=0.028）。两组间的其他结果，包括HHS、活动范围（屈曲和外展）、手术时间、术中失血和并发症发生率相似。
同期BTHA有可能比分期BTHA提供更小的LLD，因为同期手术能够基于关节外和关节内测量在术中比较双侧下肢长度。这种方法可能有利于提高术后患者满意度。
