Bilateral total hip arthroplasty: one-stage versus two-stage procedure

Despite several studies, controversy has prevailed over the rate of complications following 1-stage and 2-stage bilateral total hip arthroplasty (THA). In the current study, we compare the complications and functional outcomes of 1-stage and 2-stage procedures.

One hundred and eighty patients (ASA class I or II) with bilateral hip osteoarthritis were assigned randomly to two equal groups. The two groups were matched in terms of age and sex. All of the surgeries were performed via the Hardinge approach using uncemented implants. In 2-stage procedures, surgeries were performed with a 6-month to 1-year interval. All patients were evaluated 1 year postoperatively.

The Harris Hip Score (HHS) averaged 84.1 and 82.6 in 1-stage and 2-stage groups, respectively (p = 0.528). The hospital stay was significantly longer in the 2-stage group (9.8 days vs. 4.9 days). The cumulative haemoglobin drop and the number of transfused blood units were the same. One patient in each group developed symptomatic deep venous thrombosis which was managed successfully. There was no patient with perioperative death, pulmonary embolism, infection, dislocation, periprosthetic fracture or heterotrophic ossification. No patient required reoperation. Two patients in the 1-stage group developed unilateral temporary peroneal nerve palsy, which was resolved after 3–4 months.

1-stage bilateral THA can be used successfully for patients with bilateral hip disease without increasing the rate of complications. Functional and clinical outcomes are comparable and hospital stay is significantly shorter.