Contralateral Total Hip Arthroplasty Staged Within Six Weeks Increases the Risk of Adverse Events Compared to Unilateral Surgery.

Autor: Serino J 3rd; Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois., Terhune EB; Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois., Burnett RA 3rd; Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois., Guntin JA; Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois., Della Valle CJ; Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois., Nam D; Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois.
Jazyk: angličtina
Zdroj: The Journal of arthroplasty [J Arthroplasty] 2023 Jul; Vol. 38 (7 Suppl 2), pp. S314-S318. Date of Electronic Publication: 2022 Dec 16.
DOI: 10.1016/j.arth.2022.12.024
Abstrakt: Background: The ideal timing for bilateral total hip arthroplasty (THA) remains controversial. This study compared 90-day outcomes after simultaneous bilateral THA and contralateral surgery in staged bilateral THA to a matched cohort of unilateral procedures.
Methods: Patients undergoing primary, elective THA during 2015 to 2020 were reviewed in a national database. Of the 273,281 patients identified, 39,905 (14.6%) were bilateral. Patients were divided into cohorts of unilateral THA, simultaneous bilateral THA, and staged bilateral THA at 1 to 14 days, 15 to 42 days, 43 to 90 days, and 91 to 365 days. Bilateral THA cohorts were matched with unilateral THA patients based on demographics and comorbidities. Ninety-day outcomes after the second THA were compared between matched groups.
Results: Simultaneous bilateral THA resulted in higher rates of transfusion (odds ratio [OR] 4.43, 95% confidence interval 2.31-2.63, P < .001), readmission (OR 2.60, 2.01-3.39, P < .001), and any complication (OR 1.86, 1.55-2.24, P < .001) compared to unilateral THA. Contralateral THA staged at 1 to 14 days increased the risk of readmission (OR 1.83, 1.49-2.24, P < .001) and any complication (OR 1.45, 1.26-1.66, P < .001) relative to unilateral THA. Contralateral THA staged at 15 to 42 days increased the risk of periprosthetic joint infection (OR 3.15, 1.98-5.19, P < .001), readmission (OR 1.92, 1.55-2.39, P < .001), and any complication (OR 1.70, 1.46-1.97, P < .001). Contralateral THA staged beyond 42 days resulted in similar or decreased rates of adverse events relative to unilateral THA.
Conclusions: Bilateral THA should be staged a minimum of 6 weeks apart in appropriately selected patients to avoid an increased risk of adverse events after the second THA compared to unilateral THA.
(Copyright © 2022 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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