Bilateral total hip arthroplasty: one stage versus two stage procedure

Area of Science:

• Orthopedic Surgery
• Arthroplasty
• Surgical Outcomes

Background:

• Bilateral total hip arthroplasty (THA) can be performed in one or two stages.
• The optimal approach regarding complications, clinical outcomes, and hospital stay remains debated.

Purpose of the Study:

• To compare early complication rates, short-term clinical outcomes, and hospital stay between single-anesthetic (1-stage) and double-anesthetic (2-stage) bilateral THA.
• To evaluate the impact of surgical timing on functional recovery and patient mobility.

Main Methods:

• Retrospective analysis of 510 bilateral THA cases divided into 1-stage (Group A, 128 hips) and 2-stage procedures (Group B: <6 weeks, 126 hips; Group C: 6 weeks-6 months, 256 hips).
• Evaluation of operative, early local, and general complications, including pulmonary embolism and deep vein thrombosis.
• Assessment of hip range of motion, pain reduction, walking capacity, and total hospital stay after an average 1.5-year follow-up.

Main Results:

• No significant differences in operative, early local, or general complication rates among the three groups.
• The 1-stage group demonstrated significantly greater improvement in range of motion for stiff hips (<50 degrees) and superior walking capacity post-procedure.
• Average hospital stay was 5–6 days shorter in the 1-stage group, leading to over 30% cost reduction.

Conclusions:

• Single-anesthetic bilateral total hip arthroplasty is a safe and effective alternative to staged procedures.
• The 1-stage approach offers significant benefits in terms of reduced hospital stay, lower costs, and improved functional recovery, particularly walking ability.
• Further research may explore patient selection criteria for optimizing 1-stage bilateral THA outcomes.