J Korean Hip Soc.  2011 Sep;23(3):200-205. 10.5371/jkhs.2011.23.3.200.

Comparison of Simultaneous Bilateral Cementless Total Hip Replacement with Staged Bilateral Cementless Total Hip Replacement in High Risk Anesthesia Group

• Hwang SK
• Kwon SM
• Chung HJ

• KMID: 2014886
• DOI: http://doi.org/10.5371/jkhs.2011.23.3.200

Abstract

PURPOSE
Simultaneous bilateral total hip replacement (THR) has some advantages, but the efficacy of simultaneous bilateral THR is still controversial in patients with high risk ASA grade. Presently, we compared simultaneous bilateral to staged THR in high-risk patients according to the ASA grade.
MATERIALS AND METHODS
We retrospectively compared 60 high risk patients (ASA grade 3 and 4) with simultaneous cementless total hip replacements with a matched group of 60 patients with staged cementless total hip replacements between January, 1991 and June, 2009. Significance was determined to be p-value < 0.05.
RESULTS
Postoperative cardio-vascular complication was found in one case of simultaneous THR, and pulmonary thromboembolism was found in two cases of staged THR and in three cases of simultaneous THR. Wound infection was found in three cases of staged THR and in two cases of simultaneous THR. Delirium was found in four cases of staged THR and in five cases of simultaneous THR. Dislocation developed in two cases of staged THR and in three cases of simultaneous THR. Blood loss was higher in the staged group, but the transfusion amount was higher in the simultaneous group. Postoperative ambulation was initiated earlier in staged THR, but at the final follow-up no statistical significance was observed. Admission time and cost were reduced in simultaneous THR.
CONCLUSION
It is considered safe to perform simultaneous cementless bilateral THA in patients with high anesthetic risk, if meticulous preoperative evaluation is done.

Keyword

Simultaneous THR; Staged THR; Cementless; ASA grade; THR complication

MeSH Terms

Anesthesia
Arthroplasty, Replacement, Hip
Delirium
Dislocations
Follow-Up Studies
Humans
Pulmonary Embolism
Research Design
Retrospective Studies
Tacrine
Walking
Wound Infection
Tacrine

Reference

1. Alfaro-Adrián J, Bayona F, Rech JA, Murray DW. One- or two-stage bilateral total hip replacement. J Arthroplasty. 1999. 14:439–445.

2. Saito S, Tokuhashi Y, Ishii T, Mori S, Hosaka K, Taniguchi S. One-versus two-stage bilateral total hip arthroplasty. Orthopedics. 2010. 33:doi: 10.3928/01477447-20100625-07.

3. Berend ME, Ritter MA, Harty LD, et al. Simultaneous bilateral versus unilateral total hip arthroplasty an outcomes analysis. J Arthroplasty. 2005. 20:421–426.

4. Macaulay W, Salvati EA, Sculco TP, Pellicci PM. Single-stage bilateral total hip arthroplasty. J Am Acad Orthop Surg. 2002. 10:217–221.

5. Ritter MA, Randolph JC. Bilateral total hip arthroplasty: a simultaneous procedure. Acta Orthop Scand. 1976. 47:203–208.

6. Park YS, Park YK, Choi HJ. Results of bilateral total hip arthroplasty-one stage 265 versus two stage procedure. J Korea Hip Soc. 1998. 10:211–215.

7. Parvizi J, Pour AE, Peak EL, Sharkey PF, Hozack WJ, Rothman RH. One-stage bilateral total hip arthroplasty compared with unilateral total hip arthroplasty: a prospective study. J Arthroplasty. 2006. 21:Suppl 2. 26–31.

8. Bhan S, Pankaj A, Malhotra R. One-or two-stage bilateral total hip arthroplasty: a prospective, randomised, controlled study in an Asian population. J Bone Joint Surg Br. 2006. 88:298–303.

9. Tarity TD, Herz AL, Parvizi J, Rothman RH. Ninety-day mortality after hip arthroplasty: a comparison between unilateral and simultaneous bilateral procedures. J Arthroplasty. 2006. 21:Suppl 2. 60–64.

10. Swanson KC, Valle AG, Salvati EA, Sculco TP, Bottner F. Perioperative morbidity after single-stage bilateral total hip arthroplasty: a matched control study. Clin Orthop Relat Res. 2006. 451:140–145.

11. Bracy D, Wroblewski BM. Bilateral Charnley arthroplasty as a single procedure. A report on 400 patients. J Bone Joint Surg Br. 1981. 63-B:354–356.

12. Kim YH, Kwon OR, Kim JS. Is one-stage bilateral sequential total hip replacement as safe as unilateral total hip replacement? J Bone Joint Surg Br. 2009. 91:316–320.

13. Hwang SK, Lee CH. Postoperative delirium after hip arthroplasty in the elderly. J Korean Hip Soc. 2010. 22:151–158.

14. Rosencher N, Kerkkamp HE, Macheras G, et al. Orthopedic Surgery Transfusion Hemoglobin European Overview (OSTHEO) study: blood management in elective knee and hip arthroplasty in Europe. Transfusion. 2003. 43:459–469.

15. Shih CH, Ho WB. One-stage versus two-stage bilateral autophor ceramic total hip arthroplasty. Clin Orthop Relat Res. 1985. 193:141–145.

16. Cammisa FP Jr, O'Brien SJ, Salvati EA, et al. One-stage bilateral total hip arthroplasty. A prospective study of perioperative morbidity. Orthop Clin North Am. 1988. 19:657–668.

17. Ritter MA, Stringer EA. Bilateral total hip arthroplasty: a single procedure. Clin Orthop Relat Res. 1980. 149:185–190.

18. Hearn SL, Bicalho PS, Eng K, Booth RE Jr, Hozack WJ, Rothman RH. Comparison of cemented and cementless total hip arthroplasty in patients with bilateral hip arthroplasties. J Arthroplasty. 1995. 10:603–608.

19. Clarke MT, Green JS, Harper WM, Gregg PJ. Cement as a risk factor for deep-vein thrombosis. Comparison of cemented TKR, uncemented TKR and cemented THR. J Bone Joint Surg Br. 1998. 80:611–613.