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Bilateral character of total hip replacement does not change the overall survival
Kalliopi Lampropoulou-Adamidou1, George A Macheras, George Hartofilakidis
11 Third Orthopaedic Department, University of Athens, KAT General Hospital, Athens - Greece.
Insights
Long-term hip replacement survival rates are similar for patients undergoing one or two surgeries. Combining data from unilateral and bilateral total hip replacement cases does not significantly alter survival analysis results.
Area of Science:
- Orthopedic Surgery
- Biostatistics
Background:
- Total hip replacement (THR) is a common procedure for hip osteoarthritis.
- Assessing long-term implant survival is crucial for patient outcomes and healthcare planning.
Purpose of the Study:
- To compare the long-term survivorship of total hip replacement (THR) in patients who had one versus two hip operations.
- To determine if combining data from unilateral and bilateral THR cases could lead to misleading interpretations.
Main Methods:
- Analysis of 266 Charnley's low-friction arthroplasties in 193 osteoarthritis patients, with a minimum 15-year follow-up.
- Survivorship analysis and Cox regression to evaluate factors influencing THR survival, including unilateral vs. bilateral operation status, age, gender, and diagnosis.
Main Results:
- The 25-year survivorship for unilateral THR was 69.2% and for bilateral THR was 66.4% (p=0.324), showing no significant difference.
- Cox regression confirmed no significant relationship between THR survival and unilateral vs. bilateral operation status, only age was significant.
- In bilateral cases, diagnosis, time between surgeries, and sequence did not significantly correlate with survivorship.
Conclusions:
- The long-term survival of total hip replacement is comparable between unilaterally and bilaterally operated patients.
- Combining data from unilateral and bilateral THR cases is acceptable for long-term survival analysis as the bilateral nature does not alter overall survival outcomes.
Abstract:
The purpose of this study was to compare the long-term survivorship of total hip replacement in unilaterally and bilaterally operated patients and try to answer the question whether analyses of combined unilateral and bilateral cases could result in erroneous interpretations. The material consisted of 266 Charnley's low-friction arthroplasties performed on 193 patients with osteoarthritis of the hip, followed for a minimum of 15 years. The 25-year survivorship of unilaterally operated hips was 69.2% (95% CI 57%-81.4%) and of bilaterally 66.4% (95% CI 57.6%-75.2%), respectively (p = 0.324). Cox regression analysis of unilateral and bilateral cases for confounding factors of gender, age and primary diagnosis confirmed that there was no significant relationship between survival of THR and whether the patient is unilaterally or bilaterally operated. Only age had a significant relationship with the survival of THR. In bilateral cases, Cox analysis for possible predictive factors found that the primary diagnosis, time interval between the two operations and sequence of the operation were not significantly correlated with the survivorship of bilateral THRs. We thus concluded that in analysing a combination of unilateral and bilateral cases, and presenting the long-term THR results, the bilateral character does not change the overall survival.
