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Published on: January 24, 2018
Incidence of contralateral THA after index THA for osteoarthritis
Siraj A Sayeed1, Aaron J Johnson, David E Jaffe
1Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA.
Insights
This study found that 22% of patients undergoing hip replacement surgery eventually need a contralateral total hip arthroplasty (THA). Risk stratification can predict which patients are low, indeterminate, or high risk for this progression.
Area of Science:
- Orthopedic Surgery
- Hip Osteoarthritis Research
- Arthroplasty Outcomes
Background:
- Over 200,000 total hip arthroplasties (THAs) are performed annually in the U.S.
- A significant percentage of patients with bilateral hip disease undergo contralateral THA, but influencing factors are not fully understood.
Purpose of the Study:
- To determine the 10-year probability of progression to contralateral THA after an initial THA.
- To identify demographic differences between patients who do and do not undergo contralateral THA.
- To assess if initial clinical symptoms or radiographic osteoarthritis severity impact contralateral THA progression.
Main Methods:
- Retrospective review of 332 patients with primary osteoarthritis undergoing unilateral THA (2001-2008) with minimum 24-month follow-up.
- Analysis of clinical, radiographic, and demographic data.
- Classification of patients into low, indeterminate, or high risk for contralateral THA.
Main Results:
- 22% of patients (74/332) underwent contralateral THA.
- The 10-year probability of remaining free of contralateral THA was 83%.
- Risk stratification showed <1% progression for low-risk, 16-24% for indeterminate-risk, and 97% for high-risk patients.
Conclusions:
- Defined high- and low-risk patient groups for contralateral THA.
- Indeterminate-risk patients may benefit from nonoperative management and warrant further multicenter study.
- Identified patient profiles for potential bilateral THA candidacy or rare need for contralateral THA.
Background:
Currently more than 200,000 THAs are performed annually in the United States. In patients with bilateral disease, the chance of subsequent contralateral THA reportedly ranges from 16% to 85%. Factors influencing contralateral THA are not completely understood.
Questions/Purposes:
We therefore determined (1) the 10-year probability free of progression to contralateral THA after index THA, (2) whether demographics differed between those who did and did not ultimately undergo contralateral THA, and (3) whether initial clinical symptoms and/or degree of radiographic osteoarthritis affects progression.
Patients And Methods:
We retrospectively identified 332 patients with minimum 24-month followup and primary osteoarthritis who underwent unilateral THA between 2001 and 2008. There were 150 men and 182 women with a mean age of 61 years (range, 27-93 years) and a mean BMI of 29.6 kg/m(2) (range, 17.6-49.2 kg/m(2)). We reviewed clinical, radiographic, and demographic data at index THA and last followup and classified patients as low, indeterminate, or high risk of undergoing contralateral THA.
Results:
Seventy-four of the 332 patients (22%) underwent contralateral THA, resulting in an 83% 10-year probability free of progression to the contralateral hip. Low-risk patients had a less than 1% chance of progression, indeterminate-risk patients had a 16% to 24% chance of progression, and high-risk patients had a 97% chance of progression.
Conclusions:
Indeterminate-risk patients may be managed nonoperatively and deserve further study with a larger multicenter analysis. We defined high- and low-risk patients who may be candidates for bilateral THA or may rarely need a contralateral THA.
Level Of Evidence:
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
