Kumar S Hiranya, Chand N Vamshikrishna, Pradeep B A, Darshan Thippeswamy, Kumar R V Chandan, Harish D V
Department of Orthopaedics, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka, India.
J Orthop Case Rep. 2025 Jun;15(6):223-231. doi: 10.13107/jocr.2025.v15.i06.5722.
Total hip arthroplasty (THA) is an effective orthopedic surgery. Patients who go through the surgery experience better functioning and overall satisfaction with their lives. Other medical ailments like rheumatoid arthritis, ankylosing spondylitis, developmental dysplasia, and avascular femoral head necrosis require both hips to undergo THA. Retrospective studies suggest simultaneous bilateral THA (sim-BTHA) utilizes fewer hospital resources, brings about a shorter length of stay, as well as fewer complications compared to traditional methods, but does seem to have a higher requirement for blood transfusions. Despite the improvements to this procedure, comprehensive comparisons regarding single-institute approaches are sparse, creating an area of need focused on analysing complications, transfusion rates, and overall hospital length stays.
This study works to evaluate both sim-BTHA and staged bilateral THA (staged-BTHA) with particular concentration on: (1) The variations in complication rates postoperatively, (2) The variations in blood transfusion amounts required postoperatively, (3) The duration of hospital stay in proportional to the surgery.
This study is a prospective cohort study that runs from January 2016 to June 2024 with a target sample size of 89 patients (44 sim-BTHA, 45 staged-BTHA). Patients were divided on the basis of age, gender, diagnosis, and other clinical parameters like ASA grade, comorbidities, hemoglobin, and bone stock, with lower-age, healthier patients in sim-BTHA group. All groups underwent a standard posterolateral approach as well as uniform perioperative protocols. Details including complications, transfusions, and length of stay were retrieved from the medical records and post-operative follow-up period of 3 months.
Rates of complications were similar (36.3% sim-BTHA vs. 60% staged-BTHA, P = 0.588). Sim-BTHA was associated with lower medical complications (Gastrointestinal: 9.1% vs. 15.6%). Compared surgical complications were similar; however, deep infections and hematomas occurred only in staged-BTHA (2.2% each). Higher transfusions were seen in sim-BTHA (36.3% vs. 20%, P = 0.086). There was a significant difference in hospital stays with sim-BTHA having shorter stays than staged BTHA (14.4 vs. 28.8 days, P < 0.001). Patients with Sim-BTHA were younger (P < 0.001), had a lesser ASA score (ASA grade 1: 65.9% vs. 40%, P = 0.003), and more diagnosed cases of ankylosing spondylitis (P = 0.002).
For younger and fitter patients, Sim-BTHA appears to be safe, with greater complications seen in staged BTHA, increased transfusion needs, and shorter hospital stays. This supports increased usage in ideal candidates.
全髋关节置换术（THA）是一种有效的骨科手术。接受该手术的患者功能得到改善，对生活的总体满意度提高。类风湿性关节炎、强直性脊柱炎、发育性髋关节发育不良和股骨头缺血性坏死等其他疾病需要双侧髋关节都接受THA。回顾性研究表明，与传统方法相比，同期双侧全髋关节置换术（sim - BTHA）使用的医院资源更少，住院时间更短，并发症也更少，但输血需求似乎更高。尽管该手术有了改进，但关于单机构方法的全面比较却很少，这就需要一个专注于分析并发症、输血率和总体住院时间的领域。
本研究旨在评估sim - BTHA和分期双侧全髋关节置换术（staged - BTHA），特别关注：（1）术后并发症发生率的差异；（2）术后所需输血量的差异；（3）与手术相关的住院时间。
本研究是一项前瞻性队列研究，从2016年1月至2024年6月，目标样本量为89例患者（44例sim - BTHA，45例staged - BTHA）。患者根据年龄、性别、诊断以及其他临床参数如ASA分级、合并症、血红蛋白和骨量进行分组，sim - BTHA组患者年龄较小且健康状况较好。所有组均采用标准后外侧入路以及统一的围手术期方案。从病历和3个月的术后随访中获取包括并发症、输血和住院时间等详细信息。
并发症发生率相似（sim - BTHA为36.3%，staged - BTHA为60%，P = 0.588）。Sim - BTHA的医疗并发症较低（胃肠道：9.1%对15.6%）。相比之下，手术并发症相似；然而，深部感染和血肿仅发生在staged - BTHA组（各为2.2%）。Sim - BTHA的输血率较高（36.3%对20%，P = 0.086）。住院时间有显著差异，sim - BTHA的住院时间比staged - BTHA短（14.4天对28.8天，P < 0.001）。Sim - BTHA组患者更年轻（P < 0.001），ASA评分更低（ASA 1级：65.9%对40%，P = 0.003），强直性脊柱炎确诊病例更多（P = 0.002）。
对于更年轻、身体状况更好的患者，Sim - BTHA似乎是安全的，staged - BTHA的并发症更多，输血需求增加，住院时间更短。这支持在理想患者中更多地使用该方法。
