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Single-Anesthetic Versus Staged Bilateral Total Hip Arthroplasty: A Matched Cohort Study

Houdek, Matthew T. MD; Wyles, Cody C. MD; Watts, Chad D. MD; Wagner, Eric R. MD; Sierra, Rafael J. MD; Trousdale, Robert T. MD; Taunton, Michael J. MD

Journal of Bone & Joint Surgery - American Volume: 4 January 2017 - Volume 99 - Issue 1 - p 48–54
doi: 10.2106/JBJS.15.01223
Scientific Articles
Disclosures

Background: There is debate regarding the role of single-anesthetic versus staged bilateral total hip arthroplasty (THA) for patients with end-stage bilateral osteoarthritis. Studies have shown that single-anesthetic bilateral THA is associated with systemic complications, but there are limited data comparing patient outcomes in a matched setting of bilateral THA.

Methods: We identified 94 patients (188 hips) who underwent single-anesthetic bilateral THA. Fifty-seven percent of the patients were male. Patients had a mean age of 52.2 years and body mass index of 27.1 kg/m2. They were matched 1:1 on the basis of sex, age (±1 year), and year of surgery (±3 years) to a cohort of patients undergoing staged bilateral THA. In the staged group, there was <1 year between procedures (range, 5 days to 10 months). Mean follow-up was 4 years for each group.

Results: Patients in the single-anesthetic group experienced shorter total operating room time and length of stay. There was no difference (hazard ratio [HR] = 0.73, p = 0.50) in the overall revision-free survival in patients undergoing single-anesthetic or staged bilateral THA. The risks of reoperation (HR = 0.69, p = 0.40), complications (HR = 0.83, p = 0.48), and mortality (HR = 0.47, p = 0.10) were similar. Single-anesthetic bilateral THA reduced the total cost of care (by 27%, p = 0.0001).

Conclusions: In this matched cohort analysis, single-anesthetic bilateral THA was not associated with an increased risk of revision, reoperation, or postoperative complications, while decreasing cost. In our experience, single-anesthetic bilateral THA is a safe procedure that, for certain patients, offers an excellent means to deal with bilateral hip osteoarthritis.

Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

1Mayo Clinic, Rochester, Minnesota

E-mail address for M.T. Houdek: Houdek.matthew@mayo.edu

E-mail address for C.C. Wyles: Wyles.cody@mayo.edu

E-mail address for C.D. Watts: Watts.chad@mayo.edu

E-mail address for E.R. Wagner: Wagner.eric@mayo.edu

E-mail address for R.J. Sierra: Sierra.rafael@mayo.edu

E-mail address for R.T. Trousdale: Trousdale.robert@mayo.edu

E-mail address for M.J. Taunton: Taunton.michael@mayo.edu

Copyright 2017 by The Journal of Bone and Joint Surgery, Incorporated
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