Tuesday, September 11, 2012

Simultaneous bilaterial hip replacements/resurfacing vs two -stage proceedures : 2 studies

(1) 2011 Jun;469(6):1627-34.

Are there benefits to one- versus two-stage procedures in bilateral hip resurfacing?

Source

Joint Replacement Institute, 2400 South Flower Street, Los Angeles, CA 90007, USA. harlanamstutz@dochs.org

Abstract

BACKGROUND:

Short-term studies report comparable complication rates of one-stage bilateral versus two-stage procedures in hip resurfacing, although the long-term effects of such procedures on survivorship, quality of life, and disease-specific scores are currently unknown.

QUESTIONS/PURPOSES:

We compared clinical scores, length of stay, complication rates, and survivorship in patients who underwent bilateral hip resurfacing grouped on the basis of one-stage versus two-stage operation.

PATIENTS AND METHODS:

We retrospectively reviewed 75 patients who underwent a one-stage procedure and 87 patients who had both hips resurfaced in separate procedures. The demographics and etiologies were similar for the two groups. The mean followup time was longer in the two-stage group (7.3 years; range, 2.6-12.3 years) than in the one-stage group (6.6 years; range, 2.6-10.9 years).

RESULTS:

We found no differences in the latest postoperative UCLA pain, walking function, and activity scores; Harris hip scores; or SF-12 scores between the two groups. The average length of stay was shorter for the one-stage group. The early complication rates were similar between the two groups. One-stage patients had a higher revision rate than the patients in the two-stage group (14 versus four hips, respectively), but this was not true for patients with femoral components 48 mm or greater in size.

CONCLUSIONS:

We found a greater rate of revisions in the one-stage group, suggesting possible long-term detrimental effects of the one-stage procedure. Our data suggest selecting patients with large component sizes if the surgeries are to be performed under one anesthesia.



(2) 2010 Oct 25;11:245.

Simultaneous bilateral hip replacement reveals superior outcome and fewer complications than two-stage procedures: a prospective study including 1819 patients and 5801 follow-ups from a total joint replacement registry.

Source

Institute for Evaluative Research in Orthopedic Surgery, University of Bern, Bern, Switzerland. emin.aghayev@memcenter.unibe.ch

Abstract

BACKGROUND:

Total joint replacements represent a considerable part of day-to-day orthopaedic routine and a substantial proportion of patients undergoing unilateral total hip arthroplasty require a contralateral treatment after the first operation. This report compares complications and functional outcome of simultaneous versus early and delayed two-stage bilateral THA over a five-year follow-up period.

METHODS:

The study is a post hoc analysis of prospectively collected data in the framework of the European IDES hip registry. The database query resulted in 1819 patients with 5801 follow-ups treated with bilateral THA between 1965 and 2002. According to the timing of the two operations the sample was divided into three groups: I) 247 patients with simultaneous bilateral THA, II) 737 patients with two-stage bilateral THA within six months, III) 835 patients with two-stage bilateral THA between six months and five years.

RESULTS:

Whereas postoperative hip pain and flexion did not differ between the groups, the best walking capacity was observed in group I and the worst in group III. The rate of intraoperative complications in the first group was comparable to that of the second. The frequency of postoperative local and systemic complication in group I was the lowest of the three groups. The highest rate of complications was observed in group III.

CONCLUSIONS:

From the point of view of possible intra- and postoperative complications, one-stage bilateral THA is equally safe or safer than two-stage interventions. Additionally, from an outcome perspective the one-stage procedure can be considered to be advantageous.




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[Looks like the two stage wins out in the resurfacing and the one stage wins out in replacments? something doesn't seem intuitive to me about these conclusions.  Maybe I am missing something?]
 
 

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