Matching the other side at staged bilateral total hip arthroplasty : investigating radiological variations in staged...

The aim of this study was to assess the variations in the positioning of components between sides in patients who underwent staged bilateral total hip arthroplasty (THA), and whether these variations affected patient-reported outcome measures (PROMs).

A retrospective review included 207 patients who underwent staged bilateral THA between June 2017 and November 2022. Leg length, the height and anteversion of the acetabular component, and the coronal and sagittal angles of the femoral component were assessed radiologically and compared with the contralateral THA. The effect of the surgical approach and the technology used on this variation was also assessed. Linear regression was used to investigate the variations between the two THAs and the PROMs.

Between the two sides, the mean leg length varied by 4.6 mm (0.0 to 21.2), the mean height of the acetabular component varied by 3.3 mm (0.0 to 13.7), the mean anteversion varied by 8.2° (0.0° to 28.7°), the mean coronal alignment of the femoral component varied by 1.1° (0.0° to 6.9°), and the mean sagittal alignment varied by 2.3° (0.0° to 10.5°). The use of the direct anterior approach resulted in significantly more variation in the alignment of the femoral component in both the coronal (1.3° vs 1.0°; p = 0.036) and sagittal planes (2.8° vs 2.0°; p = 0.012) compared with the use of the posterior approach. The posterior approach generally led to more anteversion of the acetabular component than the anterior approach. The use of robotics or navigation for positioning the acetabular compoment did not increase side-to-side variations in acetabular component-related positioning or leg length. Despite considerable side-to-side variations, the mean Hip disability and Osteoarthritis Outcome, Joint Replacement (HOOS JR) score was not affected by variations in the postioning of the components.

Staged bilateral THA resulted in considerable variation in the positioning of the components between the two sides. The direct anterior approach led to more variations in anteversion of the acetabular component and sagittal alignment of the femoral component than the posterior approach. The use of computer navigation and robotics did not improve the consistency of the positioning of the components in bilateral THA. Variations in the positioning of the components was not associated with differences in PROMs, indicating that patients can tolerate these differences.