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A retrospective analysis of the merits and challenges associated with simultaneous bilateral THA using the direct anterior approach

A retrospective analysis of the merits and challenges associated with simultaneous bilateral THA using the direct anterior approach

Hip Int 2017; 27(2): 169 - 174

Article Type: ORIGINAL RESEARCH ARTICLE

DOI:10.5301/hipint.5000449

Authors

Matthew L. Brown, Johannes F. Plate, David C. Holst, Daniel N. Bracey, Matthew W. Bullock, Jason E. Lang

Abstract

Introduction

15%-20% of patients presenting for total hip arthroplasty (THA) have bilateral disease. While simultaneous bilateral THA is of interest to patients and surgeons, debate persists regarding its merits. The majority of previous reports on simultaneous bilateral THA involve patients in the lateral decubitus position, which require repositioning, prepping and draping, and exposure of a fresh wound to pressure and manipulation for the contralateral THA. The purpose of this study was to compare complications, component position, and financial parameters for simultaneous versus staged bilateral THAs using the direct anterior approach (DAA).

Methods

Medical records were reviewed for patient demographics, medical history, operative time, estimated blood loss (EBL), change in hemoglobin, transfusion, tranexamic acid (TXA) use, length of stay (LOS), discharge disposition, leg length discrepancy, acetabular cup position, and perioperative complications. Cost and reimbursement data were analysed.

Results

44 patients were included in the sequential group and fifteen patients in the simultaneous group. Operative time, EBL, hemoglobin drop, transfusion rate, and LOS were significantly increased for simultaneous group. There was no significant difference in component position, complications, or readmissions between groups. Profit per hip was significantly higher for the simultaneous group.

Discussion

While simultaneous DAA THA presents challenges, our results suggest that simultaneous DAA THA may add value to the healthcare system without resulting in increased complications compared to sequential hip arthroplasty.

Article History

Disclosures

Financial support: None.
Conflict of interest: None.

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Authors

Affiliations

  • Department of Orthopaedic Surgery, Wake Forest University Baptist Medical Center, Winston-Salem - USA

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