Bilateral Hip Arthroplasty: When Is It Safe to Operate the Second Hip? A Systematic Review

Abstract

Introduction Patients with degenerative hip disease frequently present with bilateral involvement that requires surgical management. The main goal when treating these patients is to achieve the maximum efficiency without increasing risk of perioperative complications; therefore, the decision regarding the best moment to operate the second hip becomes relevant. Although studies have addressed this topic, whether a simultaneous or staged surgery should be performed remains controversial. The purpose of this study was to determine, based on available evidence, the optimum strategy in terms of safety to operate the second hip in patients with bilateral involvement. Materials and Methods A meta-analysis was planned. A systematic review of the literature was performed including clinical trials or observational analytical studies comparing the safety of bilateral arthroplasty performed simultaneously or staged by measuring major and minor complications. The appropriateness of a meta-analysis was evaluated through the detailed analysis of the risk of bias and clinical heterogeneity of the included studies. Results Thirteen studies were selected after the systematic review. A wide variability in the methodological designs was found with a critical risk of bias in most of them. Considerable heterogeneity was detected in defining staged surgery in the cointerventions and how the outcomes were defined and measured. In response to these findings, a meta-analysis was considered not appropriate. The results showed no differences in the risk of mortality or systemic complications in young and healthy patients between simultaneous or staged surgeries. However, increased risk of complications for staged surgeries performed during the same hospitalization was observed. Conclusions Available evidence is very heterogeneous and the quality of evidence is low. The available evidence supports the performance of simultaneous hip arthroplasty in selected patients (not older than 65 years, ASA 1-2, without cardiovascular comorbidities) and suggests the avoidance of staged surgeries within the same hospitalization.

The Symmetry and Predictive Factors in Two-Stage Bilateral Hip Replacement Procedures

“…The purpose of total hip arthroplasty is to restore the function of the treated limb, improve the range of motion, reduce pain, and allow the patient to return to their normal activities, which improves the quality of life and the state of health in all its aspects [8,10]. Approximately 10-25% of people with bilateral degenerative joint disease of the hip undergo bilateral total hip replacement surgery [3,[7][8][9]11]. There is no 'gold standard' for the management of patients with bilateral osteoarthritis of the hip [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20].…”

“…Bilateral total hip replacement has been recommended in patients with osteoarthritis of both hip joints [3][4][5][6]. Approximately 10-25% of total hip replacement patients undergo a bilateral procedure [3,[7][8][9].…”

“…There are two management strategies in bilateral hip disease: a simultaneous (i.e., onestage) bilateral total hip arthroplasty or a two-stage procedure, with total hip arthroplasty of one hip at a time [3][4][5][6][7][8][9][10][11]. Although either strategy is favored by some orthopedic surgeons [3][4][5][6][7][8][9][10][11], most reports advocate the two-stage management, due to less severe complications, not as extensive procedures, less blood loss, more rapidly resumed daily functioning, and a shorter period of rehabilitation after arthroplasty on only one side [3,6,8]. The two-stage strategy may also be more beneficial for patients with bilateral osteoarthritis of the hip than the simultaneous bilateral arthroplasty, as the former affords an opportunity to assess the predictive factors for the second procedure [3,4].…”

The Safety of Bilateral Simultaneous Hip and Knee Arthroplasty versus Staged Arthroplasty in a High-Volume Center Comparing Blood Loss, Peri- and Postoperative Complications, and Early Functional Outcome

“…However, systemic reviews of THA and TKA were not always conclusive for simultaneous versus staged arthroplasty [ 14 , 15 ]. This study aimed to compare the safety of bilateral simultaneous THA and TKA versus staged arthroplasty in a high-volume center.…”

Factors Affecting Discharge Disposition after Primary Simultaneous Bilateral Joint Arthroplasty

“…Bilateral total joint arthroplasty (BTJA) can be performed simultaneously under the same anesthetic or as staged procedures—two unilateral arthroplasties under separate anesthetics and hospitalizations. The performance of simultaneous bilateral total hip arthroplasty (PSBTHA) has been on the rise in recent years, with advantages including reductions in cost, rehabilitation time, and hospital length of stay without a heightened risk of complications [19, 22, 23, 25, 32]. It has been argued that primary simultaneous bilateral total knee arthroplasty (PSBTKA) provides pain relief, restores independence, and improves quality of life and function [1, 28, 29].…”