Sequential Bilateral Total Hip Replacement during the Same Hospitalization

Numerous authors describe the efficacy and relative safety of simultaneous bilateral total hip replacement or bilateral surgeries separated by more than 6 weeks. We compare those reported results with our 32-year experience using a unique timing protocol: doing sequential bilateral total hip replacements during the same hospitalization separated by 5 to 7 days. From 1972 to 2004, 112 patients were selected for bilateral total hip replacement surgery during the same hospitalization. All surgeries were done using a direct lateral approach to the hip with a variety of cemented and cementless implants. Of the 112 patients, 96 charts were available for review. The average length of stay was 13.8 days. With an average of 6.3 years (range, 1-23 years) followup, Iowa hip scores improved from an average of 42 points to an average of 94 points. Implant survivorship compared favorably with other reports of similar implants, and there were no acute deep infections and two delayed infections. Sixteen patients developed medical complications, two had pulmonary emboli (one fatal) and two died (one of pulmonary embolism and one cerebral bleed not related to the surgery). Sequential bilateral total hip arthroplasty offers surgeons an alternative to simultaneous or staged surgery for the appropriately selected patient.

Level of Evidence: Therapeutic study, Level IV (case series). See the Guidelines for Authors for a complete description of levels of evidence.