Need for bilateral arthroplasty for coxarthrosis. 1,477 replacements in 1,199 patients followed for 0-14 years

Area of Science:

• Orthopedic Surgery
• Epidemiology
• Biostatistics

Background:

• Osteoarthritis (OA) is a leading cause of hip disability.
• Total hip arthroplasty (THA) is a common surgical intervention for end-stage OA.
• Understanding the long-term implications of unilateral THA is crucial for patient management.

Purpose of the Study:

• To determine the cumulative risk of contralateral hip replacement in patients who have undergone primary total hip arthroplasty for osteoarthritis.
• To compare the incidence of contralateral hip replacement with the general population.

Main Methods:

• Retrospective cohort study analyzing 1,477 primary total hip arthroplasties (THA) for osteoarthritis (OA) performed between 1981-1990.
• Patient follow-up until the end of 1994, with a mean follow-up of 5.6 years.
• Calculation of cumulative risk for contralateral hip replacement and comparison with general population rates.

Main Results:

• The cumulative risk of contralateral hip replacement was approximately 0.15 at 1 year, 0.20 at 2 years, 0.29 at 5 years, and 0.47 at 10 years post-initial THA.
• Patients who received a unilateral THA had a demand for contralateral hip replacement approximately 15 times higher than the general population.
• Bilateral operations were performed in 356 patients; 248 patients died with only one THA during the follow-up period.

Conclusions:

• Patients undergoing primary total hip arthroplasty for osteoarthritis face a substantial and persistent elevated risk of requiring a contralateral hip replacement.
• The findings underscore the high incidence of bilateral hip osteoarthritis and the need for proactive management strategies.
• The significantly higher demand for contralateral THA highlights the progressive nature of osteoarthritis in the hip joint.