One-stage bilateral versus unilateral short-stem total hip arthroplasty: A matched-pair analysis of 216 hips

One-stage, bilateral, short-stem total hip arthroplasty (1B-ssTHA) represents an alternative to staged, unilateral, short-stem total hip arthroplasty (U-ssTHA); however, the safety and reliability of 1B-ssTHA remain unknown. The objective of the present study was to compare the functional outcomes, complications, and mortality rates between 1B-ssTHA and U-ssTHA at mid-term.

A retrospective, matched-pair study was performed, including 216 short stems implanted in 162 patients. Among the study population, 54 patients were treated with 1B-ssTHA. Patients were matched by gender, age, body mass index (BMI), and American Society of Anesthesiologists (ASA) classification. A total of 46 full matches could be accomplished. The mean follow-up time for the 1B-ssTHA group was 61.7 months (standard deviation [SD] 6.2 months), compared with was 63.4 months (SD 8.0 months) for the U-ssTHA group. Mortality, complication, and revision rates were documented. For clinical examinations, the visual analogue scale (VAS) was used to evaluate satisfaction, rest pain, and load pain, and the Harris Hip Score (HHS) was determined.

No surgery-related deaths were observed. At mid-term, none of the 1B-ssTHA patients required stem revision. The rate of complications for both groups was low. The mean drop in haemoglobin measured in the 1B-ssTHA group was 4.42 mg/dl, compared with 3.18 mg/dl in the U-ssTHA group. The mean HHS in the 1B-ssTHA group was 98.3 points (SD 2.80), whereas, in the U-ssTHA group, the mean HHS was 97.9 points (SD 3.44) (p = 0.478). Satisfaction rates were significantly higher in the 1B-ssTHA group (p = 0.04) than in the U-ssTHA group, whereas no significant differences were found for pain at rest and pain at load (p = 0.56 and p = 0.26, respectively).

Our findings indicate that 1B-ssTHA is an effective and beneficial procedure for a select population. Mortality, complications, implant survival, and clinical outcomes were comparable to those for a matched group with unilateral osteoarthritis treated with U-ssTHA. However, an increase in blood loss must be acknowledged for the 1B-ssTHA procedure.