Bilateral Total Hip Arthroplasty: One-stage versus Two-stage Procedures

We compared the outcomes of bilateral total hip arthroplasty performed as a one-stage or two-stage procedure. We retrospectively identified 196 patients (392 hips) with bilateral arthritis of the hip who underwent total hip arthroplasties: 98 patients (196 hips) as a one-stage procedure (one-stage group) and 98 (196 hips) as a two-stage procedure (two-stage group). All patients had uncemented components implanted under spinal anesthesia and had the same postoperative rehabilitation protocol. Both groups’ functional outcomes were similar. The mean preoperative hemoglobin was 12.6 g/dL in the one-stage group and 12.9 g/dL in the two-stage group. The mean cumulative blood transfusion was 2.6 units in the one-stage group and 3.5 units in the two-stage group. Patients in the two-stage group had more complications, most commonly anemia and wound drainage. The total mean hospital stay was longer in the two-stage group (8.1 days; range, 5-39 days) compared with the one-stage group (4.3 days; range, 3-11 days). The mean total expenses were higher in the two-stage group ($64,600) compared with the one-stage group ($45,900). Young and healthy patients may be candidates for one-stage bilateral total hip arthroplasty without an increase in complications and with lower costs.

Level of Evidence: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.