Perioperative Morbidity after Single-stage Bilateral Total Hip Arthroplasty: A Matched Control Study

We asked whether the perioperative morbidity and mortality of patients having bilateral single-stage total hip arthroplasties would be increased. We retrospectively compared 400 patients who had bilateral total hip replacements with a matched group of 400 patients who had unilateral total hip replacements. Patients were matched according to age (± 1 year), gender, American Society of Anesthesiologists (ASA) classification, body mass index (± 4 kg/m²), and diagnosis (osteoarthritis, 81.2%). There were no deaths in either group. The group of patients who had bilateral total hip arthroplasties had a greater number of minor complications per hip (0.34 ± 0.6 versus 0.25 ± 0.6) but only a trend toward an increased number of major complications per hip (0.037 ± 0.2 versus 0.015 ± 0.1). Patients who had bilateral total hip arthroplasties had a trend toward increased risk of dislocation (1.6%/hip versus 0.5%/hip). The patients in this group also had increased number of fat emboli syndrome per surgically treated hip (0.015 versus 0.0025). Based on a calculation per surgically treated hip, patients who had bilateral total hip arthroplasties had a similar percentage of blood transfusions (1.2 versus 0.9/hip), but more patients received allogeneic blood (23% versus 3.8%). The ASA classification was the only independent predictor for minor complications, major complications, and fat emboli syndrome. We think bilateral single-stage total hip arthroplasties have an acceptable perioperative risk for patients with ASA Class 1 or 2 physical status.

Level of Evidence:

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