Simultaneous or Staged Bilateral Total Hip Arthroplasty: An Analysis of 82,897 Patients.

Abstract

Total hip arthroplasty (THA) is one of the most common orthopaedic procedures. Although unilateral THA is routine, there is limited guidance on managing patients who require bilateral arthroplasty. This study aims to compare the outcomes of simultaneous versus staged bilateral THA. This was a cohort retrospective study drawing data from the National Readmissions Database, years 2016 to 2020. Patients undergoing bilateral THA were identified using International Classification of Diseases, 10th Revision, Clinical Modification/Procedure Coding System (ICD-10) codes. For staged procedures, outcomes for each surgery were combined for appropriate comparison with simultaneous surgeries. Propensity score matching was performed to balance patient demographics, socioeconomic status, and comorbidities, between the two groups. Multivariate regression was performed to assess outcomes between groups. Multivariate regression analyses were conducted on the matched cohorts to assess postoperative outcomes, 90-day readmission, and 90-day revision surgery rates. A total of 82,897 patients, 71,560 (86.3%) undergoing staged bilateral and 11,337 (13.7%) undergoing simultaneous bilateral THA, were included. After successful matching, those undergoing staged bilateral THA had increased medical (odds ratio [OR], 1.26; P < 0.001), but reduced surgical complications (OR, 0.66; P < 0.001), particularly reduced need for blood transfusions (OR, 0.38; P < 0.001). Those undergoing the staged procedure also had reduced odds of revision surgery (OR, 0.85; P = 0.001) but increased odds of readmission (OR, 1.14; P < 0.001), routine discharge (OR, 1.20; P < 0.001), longer lengths of stay (OR, 1.09; P < 0.001), and greater total charges (OR, 1.20; P < 0.001). When compared with simultaneous THA, staged THA was associated with reduced surgical complications, particularly transfusions, but greater medical complications. Although associated with reduced revision surgeries and resulted in better discharge disposition, staged bilateral THA required more days in the hospital and were more expensive. This suggests that both simultaneous and staged bilateral THA are viable options. Surgeons should consider individual patient risks and preferences when planning bilateral THA. Level III; Retrospective Cohort Study.