Simultaneous vs staged cementless bilateral total hip arthroplasty: perioperative risk comparison

Simultaneous vs staged bilateral total hip arthroplasty (THA) continues to evoke controversy, with perioperative complications representing the most significant issue. Previous authors have reported significant cost savings by performing bilateral THA simultaneously, but have failed to address issues of surgeon and hospital reimbursement. This study compares 277 consecutive patients undergoing either simultaneous (334 THAs) or staged bilateral cementless THA (220 THAs) in lateral decubitus position using a single cementless stem design, with emphasis on perioperative complications and reimbursement to surgeon and hospital. There were significantly more inpatient complications and adverse events in patients undergoing simultaneous bilateral THA in the lateral decubitus position, significantly higher transfusion requirement, and more patients failing to reach physical therapy goals during admission requiring more transfers to rehabilitation facilities. Need for subsequent hip surgery was also significantly higher in simultaneous bilateral patients. In addition to these negative results, the hospital system realized a 28% reduction and the surgeon suffered a 15% reduction in potential reimbursement.