End-stage osteoarthritis in both hip joints always raises the question of whether they should be operated on at the same time or in two separate procedures. The dilemma of operating on each hip separately, with an interval of three months, or replacing both joints at the same time, that is in a single operation, remains a live one. Those who support the first view stress the smaller number of complications and the generally lower risk to the patient when only one joint is operated on, while the second view is supported by those who emphasise the greater practicality of dealing with two problems at once.
Many studies have been published in the international literature and this difference of opinion remains a live one. A recent study compared the complications and functional results of this operation carried out in one stage and in two stages.
Data were analysed from 180 patients with bilateral hip osteoarthritis, who were randomly allocated to two groups. All the operations were carried out through a Hardinge approach using cemented implants. Where the procedure was performed in two stages, the operations were carried out with an interval of six months to one year. All the patients were assessed one year postoperatively.
The Harris Hip Score (HHS) showed a mean of 84.1 and 82.6 in the one-stage and two-stage groups respectively (p = 0.528). The hospital stay was significantly longer in the two-stage group (9.8 days versus 4.9 days). The overall fall in haemoglobin and the number of units of blood transfused were the same. One patient in each group developed a deep vein thrombosis, which was treated successfully. No patient suffered intraoperative death, pulmonary embolism, infection, dislocation, periprosthetic fracture or heterotopic ossification. No patient required a reoperation. In two patients in the one-stage group a unilateral transient peroneal nerve palsy was observed, which resolved after a period of three to four months.
The authors concluded that bilateral total hip arthroplasty in one stage can be used successfully for patients with bilateral hip osteoarthritis, without any increase in the complication rate. The functional and clinical results are comparable in both groups, while the hospital stay is significantly shorter.
Source: “Hip International”, May 2018
