Simultaneous versus staged bilateral total hip arthroplasty: a meta-analysis

There is debate regarding the optimal timing of bilateral total hip arthroplasty (THA), with simultaneous or staged approaches considered. Cost-effectiveness is an important factor that influences resource allocation. The main aim of this study was to assess the cost implications of bilateral simultaneous (sim-THA) versus staged (st-THA) total hip arthroplasty. The secondary objective was to evaluate the efficacy and safety of sim-THA compared those with of st-THA.

A systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Studies comparing simultaneous and staged bilateral THA in terms of cost, complications, length of hospital stay, and patient outcomes were eligible. Odds ratios (ORs), mean differences (MD), and standard mean differences (SMD) with 95% confidence intervals (CIs) were calculated. The risk of bias was assessed using the Methodological Index for Non-randomised Studies (MINORS). Meta-analyses were performed using Review Manager version 5.4 (Cochrane, Oxford, United Kingdom).

A total of 20 observational studies including 13,984 patients were included. Sim-THA was associated with significantly lower total costs (SMD -0.54, 95% CI -0.92 to -0.16; p = 0.005) and shorter hospital stay (MD -2.90, 95% CI -4.38 to -1.42; p = 0.0001) than those in the st-THA group. Revisions were less frequent in the sim-THA group (OR 0.44, 95% CI 0.36-0.53; p < 0.00001). No differences were observed in mortality (OR 1.01, 95% CI 0.31-3.28; p = 0.98) or readmission rates (OR 0.58, 95% CI 0.23-1.44; p = 0.24). The number of transfusions (OR 4.42, 95% CI 2.18-8.99; p < 0.0001) was lower in st-THA. Functionality (SMD 0.37, 95% CI 0.20-0.53; p < 0.0001) and pain scores (SMD 0.19, 95% CI 0.04-0.33; p = 0.01) favored sim-THA.

A meta-analysis of 20 studies demonstrated that sim-THA offers economical and clinical advantages, including reduced hospital expenses and improved patient quality of life, despite a higher number of transfusions, with comparable surgical blood loss to standard THA.