Page 3 - OrthoFeed issue3 - Final

Case series

Simultaneous bilateral total hip arthroplasty

Dr HP Bhalodiya Table 1- Reporting 3 cases of SimBTHA [3]

MS, Orthopedics and joint replacement surgeon Case 1 Case 2 Case 3
Chief joint replacement surgeon at Saviour Age 66 years 56 years 62 years
Hospital, Ahmedabad BMI 35 33 26.6

Introduction Age 66 years 56 years Older age
62 years
Simultaneous bilateral total hip arthroplasty (SimBTHA) BMI 35 33 26.6
can be performed when the patient is
Comorbidities Prostate cancer Hypertension Obstructive
Young [1] in remission sleep
Hyperlipidemia
Free from comorbidities [1]
Hypothyroidism
Suffering from bilateral hip disease [1]
Blood loss 200 ml 200 ml 150ml
If patients are deemed not suitable for SimBTHA, it may during surgery
be more appropriate to perform staged bilateral total hip
arthroplasties (StBTHAs) 3-6 months apart to minimize Duration of 116 minutes 130 minutes 103 minutes
surgery
complications and morbidity. [1]
Time taken to 2 hours 7 hours 4 hours
discharge after
Analysing SimBTHA in contrast to surgery
StBTHA Time taken to 3 months 3 months 3 months
achieve
normal gait
Advantages of SimBTHA Limitations of SimBTHA
Improvement Improved from Improved from Improved from
in Harris Hip 71 to 91 45 to 100 63 to 100
Reduced anesthetic time [1] Greater risk of pulmonary Score (HHS)
embolism, myocardial
Reduced duration of infarction, renal failure Post-operative Rivaroxaban for Rivaroxaban Rivaroxaban
rehabilitation [1] and chest infection [1] thromboproph 4 weeks for 4 weeks for 4 weeks
ylaxis
Shorter overall hospital Significantly higher
stay (8.9 days vs 10.4 days) absolute mortality (0.4%
[1] [1] Conclusion
vs 0.1%)
Cost-effective [1] Simultaneous bilateral THA appears to be beneficial for
both the patient and the health-care system due to lesser
Patients of working age duration of hospital stay, anesthetic time and
benefit from shorter time rehabilitation. [3]
off work. [1]
But, it is associated with increased risk of postoperative
complications. [3]
The functional outcomes of SimBTHA and StBTHAs are Therefore, surgeons performing SimBTHA should ensure
reported to be similar with average Harris Hip Score rigorous patient selection and obtain informed consent
(HHS) of 84.1 and 82.6, respectively. (p = 0.528). [2]
from their patients. [1]

Case series References
zBrzezinski et al. reported 3 cases describing the 1. Partridge, T. C. J., Charity, J. A. F., Sandiford, N. A., Baker, P.
feasibility, safety, and efficacy of performing N., Reed, M. R., & Jameson, S. S. (2019). Simultaneous or Staged
SimBTHA in patients with degenerative joint disease Bilateral Total Hip Arthroplasty? An Analysis of Complications
of both hips. (Table 1) [3] in 14,460 Patients Using National Data. The Journal of
Arthroplasty. doi:10.1016/j.arth.2019.08.022
None of the patients required a blood transfusion, 2. Taheriazam A, Mohseni G, Esmailiejah AA, Safdari F,
experienced a deep vein thrombosis (DVT) or Abrishamkarzadeh H. Bilateral total hip arthroplasty: one-stage
pulmonary embolism (PE). [3] versus two-stage procedure. HIP International.
2019;29(2):141-146. doi:10.1177/1120700018773427
There were no complications and excellent outcomes 3. A. Brzezinski et al. Single-Stage Bilateral Total Hip
at 90-day follow-up. [3] Arthroplasty in an Ambulatory Surgical Center: A Report of
Three Cases. Arthroplasty Today 8 (2021) 74e77.