Simultaneous primary bilateral hip resection arthroplasty
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ABSTRACT:
SUBMITTER: Than J
PROVIDER: S-EPMC8567162 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:A 16-year-old girl who had Morquio syndrome presented with severe bilateral hip pain and limited mobility because of bilateral hip osteoarthritis and fixed flexion deformities. She was wheelchair bound for the previous 6 months. Cervical spine flexion-extension views showed mild subluxation (<3 mm), and there was thoracolumbar spine kyphosis. Magnetic resonance imaging of the cervical and thoracolumbar spine showed hypoplasia of the odontoid and vertebral bodies, but no spinal cord compression. Bilateral cemented total hip arthroplasty was performed through a posterior approach under general anesthesia with fiberoptic intubation. The femoral canals accepted a small-diameter stem, the right femoral head was used as a graft for superior right acetabular deficiency, and low-profile all-polyethylene acetabular cups were implanted. Follow-up at 15 years after surgery showed that the patient was fully ambulatory without pain or supports, and radiographs showed no loosening. In summary, total hip arthroplasty at a young age may be necessary in patients who have Morquio syndrome because of severe arthritis and soft tissue contractures. Extensive preoperative evaluation that includes imaging of the entire spine is mandatory because of the risk of developing spinal cord compression.
| S-EPMC5585770 | biostudies-literature
Project description:Background:Predicting discharge destination following total joint arthroplasty (TJA) is important, as discharge destination has major implications for post-operative costs, clinical outcomes, and readmissions. Few studies have looked at factors affecting discharge destination for patients following primary simultaneous bilateral total joint arthroplasty. Questions/Purposes:The purpose of this study was to describe clinical and social factors that relate to a discharge to home versus rehabilitation facility (RF) for patients after primary simultaneous bilateral total hip arthroplasty (PSBTHA) or primary simultaneous bilateral total knee arthroplasty (PSBTKA). Methods:The inclusion criteria for this retrospective cohort study were all patients after PSBTHA or PSBTKA at a metropolitan orthopedic specialty hospital between February 1, 2016, and March 31, 2018. Exclusion criteria were revisions, differing weight-bearing status, bed-rest orders, and non-standard hip precautions. Social and clinical demographic data were collected. Multiple regression analysis was conducted to determine which factors related most to discharge plan. Results:Of 253 PSBTHA patients, 153 were discharged home and 100 to an RF. Regression analysis found a posterolateral approach to be the only significant factor associated with an RF discharge. Of 619 PSBTKA patients, 136 were discharged home and 483 to RF. Increased body mass index and older age increased the likelihood of discharge to an RF. Patients with an adductor-only nerve block were more likely to be sent to RF. Conclusion:These findings shed light on the variables that contribute to discharge destination after PSBTHA and PSBTKA. Such information allows for safe pre-operative discharge planning and assists with discharge to the appropriate level of patient care. Future studies might investigate the effect of surgeon experience, surgical technique, and pre-operative discussion with a physical therapist on the discharge disposition of patients undergoing bilateral total joint arthroplasty.
| S-EPMC6778168 | biostudies-literature
Project description:Many patients are afflicted with painful conditions affecting both hips, most commonly femoroacetabular impingement. Some patients prefer the advantage of undergoing a single surgical procedure and anesthetic followed by a single postoperative rehabilitation program. We present a Technical Note on single-stage bilateral hip arthroscopy. This Technical Note reports on key steps enabling safe and efficient performance of bilateral arthroscopic acetabuloplasty, labral refixation, femoroplasty, and dynamic testing while limiting traction times and facilitating rapid transition to the second hip arthroscopic surgery. Enabling factors include supine positioning with bilateral mobile leg spars, rapid surgical and hip traction times, and postoperative rehabilitation with immediate weight bearing as tolerated. A rationale for deciding which hip should undergo arthroscopy first is also offered. Concurrent bilateral hip arthroscopy is a viable option for select patients and experienced surgical teams, enabling potentially expedited recovery and return to work or sport with inherent cost savings.
| S-EPMC5800958 | biostudies-literature
Project description:Bilateral acetabular fractures in elderly patients due to seizures are very rare and management is a challenge. The standard treatment for acetabular fracture, open reduction with internal fixation, is not recommended for the elderly because of poor bone quality and the need for bed rest. In the acute phase, total hip arthroplasty may be the best treatment option because it allows early mobilization and avoids bed rest complications. We report the case of a 76-year-old man with a bilateral comminuted acetabular fractures and a left fracture dislocation of the shoulder, treated by immediate shoulder arthroplasty and a one-stage bilateral total hip arthroplasty procedure at 3 weeks, with a good result at 1-year follow-up.
| S-EPMC6588820 | biostudies-other
Project description:PurposeIncreased blood loss remains a major drawback of simultaneous bilateral total hip arthroplasty (SBTHA). We examined the effects of disusing closed suction drainage (CSD) on postoperative blood loss and transfusion requirement in cementless SBTHA.MethodsA retrospective cohort study was conducted with a consecutive series of cementless SBTHAs performed by a single surgeon between January 2014 and March 2017. The surgeon routinely used CSD until May 2015 and refrained from CSD in all primary THAs thereafter. This study included SBTHAs with intravenous administration of tranexamic acid (TXA). Postoperative hemoglobin drop, blood loss, transfusion rate, pain scores, complication rates, and implant survivorships were compared between the groups of SBTHA with and without CSD. The minimum follow-up duration was 1 year.ResultsAmong the 110 patients (220 hips), 46 (92 hips) and 64 (128 hips) underwent SBTHA with and without CSD, respectively. Maximum hemoglobin drop (mean, 4.8 vs. 3.9 g/dL; P = 0.001), calculated blood loss (mean, 1530 vs. 1190 mL; P<0.001), transfusion rate (45.7% vs. 21.9%; P = 0.008), and length of hospital stay (mean, 6.6 vs. 5.8 days; P = 0.004) were significantly lower in patients without CSD. There were no significant differences in postoperative pain scales and wound complication rates. The mean Harris Hip scores at final follow-up (92.5 vs. 92.1; P = 0.775) and implant survivorships with an end-point of any revision at 4 years (98.9% vs. 98.4%; log-rank, P = 0.766) were similar between groups.ConclusionsDisusing CSD significantly reduced postoperative blood loss and transfusion requirement without increasing postoperative pain and surgical wound complications in cementless SBTHA with concurrent administration of intravenous TXA.
| S-EPMC7928457 | biostudies-literature
Project description:Acetabular fractures after seizures are uncommon, and fewer than 30 cases are described in the literature. We present a patient with bilateral acetabular fractures after a seizure, with bilateral quadrilateral plate destruction and protrusio deformity. The patient underwent delayed staggered bilateral total hip arthroplasty 3 months after initial injury, with use of the femoral head as autograft for the protrusio deformities.
| S-EPMC7303498 | biostudies-literature
Project description:BackgroundTotal hip arthroplasty (THA) relieves pain and restores function in patients with severe rheumatoid arthritis and osteoarthritis. Over the past few decades, several authors have attempted to assess the efficacy and safety of simultaneous bilateral THA compared with staged bilateral THA. The purpose of this meta-analysis is to compare the mortalities and complications between simultaneous bilateral THA and staged bilateral THA.MethodsA literature search to identify eligible studies was undertaken to identify all relevant articles published until August 2018. We included studies that compared simultaneous bilateral THA and staged bilateral THA and their effects on mortality and complications. The outcomes included mortality, the occurrence of deep venous thrombosis (DVT), the occurrence of pulmonary embolism (PE), respiratory complications, cardiovascular complications, digestive system complications and the occurrence of dislocation. Stata 12.0 was used for the meta-analysis.ResultsNineteen studies involving 59,257 patients were identified; among them, 16,758 patients were selected for treatment with simultaneous bilateral THA, and 42,499 patients were chosen for the purpose of staged bilateral THA. The meta-analysis results demonstrated that there was no significant difference between simultaneous bilateral THA and staged bilateral THA in terms of mortality (risk ratio [RR]?=?1.15, 95% CI?=?0.76, 1.74; P?=?.520). Compared with staged bilateral THA, simultaneous bilateral THA was associated with a reduction in the occurrence of DVT, PE and respiratory complications (P?<?.05). There were no significant differences in the cardiovascular complications, digestive system complications or the occurrence of dislocation and infection (P?=?.057).ConclusionsWe observed that the prevalence of DVT, PE and respiratory complications was considerably lower with the use of simultaneous bilateral THA than with the use of staged bilateral THA. Thus, simultaneous bilateral THA is a considerably safer procedure than staged bilateral THA in selected THA patients.
| S-EPMC6775426 | biostudies-literature
Project description:BackgroundAchieving appropriate leg length after surgery remains a concern for surgeons performing total hip arthroplasty (THA). The focus of surgeons trying to equalize leg length has been primarily on positioning of the femoral implant. This study evaluates the impact of acetabular height on leg length and its impact on femoral component choices during THA.MethodsWe reviewed standing pelvic radiographs of 100 patients who underwent staged bilateral THA by a single surgeon from 2016 to 2019. Leg length discrepancies and acetabular heights were determined from preoperative and postoperative radiographs. The difference between the first and second operative hips was compared at each stage of the procedures. Results were analyzed using paired t-tests.ResultsThere is a significant increase in mean leg length and acetabular height after both the first and second stages of the procedure. Although there was a small change in average acetabular height for each procedure, height increased or decreased by greater than 5 mm in 44 of 200 cases. Comparing left to right hips after the second surgery disclosed no statistically significant differences in acetabular height or leg length.ConclusionAcetabular height and leg length changes with each stage of the procedure in sequential bilateral THA. In almost 25% of cases, the acetabular height changed by more than 5 mm. This has significant implications and needs to be considered during preoperative planning as well as operative decision-making. To account for these differences, a THA may require intraoperative acetabular assessment and changes in femoral positioning and sizing to achieve the optimal leg length.
| S-EPMC8891997 | biostudies-literature
Project description:BackgroundThe association of simultaneous bilateral total hip arthroplasty (THA) with postoperative deep venous thrombosis (DVT) remains controversial. The aim of the study is to determine whether simultaneous bilateral THA without chemoprophylaxis has a higher risk than unilateral THA without chemoprophylaxis.MethodsThis is a population-based retrospective cohort study of all adults who underwent primary THA without any anticoagulant or antiplatelet therapy between July 2012 and March 2021 at the Department of Orthopedic Surgery, Toranomon Hospital, Tokyo, Japan. The association of simultaneous bilateral THA with postoperative DVT was examined by unadjusted analysis and overlap propensity score weighting. The primary outcome was the incidence of DVT (confirmed by ultrasonography of the lower limb veins) within 7 days postoperatively.ResultsOf the 557 consecutive patients who underwent primary THA in the study period, 458 met the inclusion criteria. The mean (standard deviation) age of these patients was 67 (11.7) years, and 364 (79.5%) were women; 75 (16.4%) of the 458 patients underwent simultaneous bilateral THA, and 383 (83.6%), unilateral THA. A total of 64 patients (14.0%) developed a postoperative venous thromboembolism, all of which were a distal DVT. The overlap weighting analysis found no significant difference in the incidence of postoperative DVT complications among patients who underwent simultaneous bilateral THA and those who underwent unilateral THA (31.1 [13.6%] vs 22.9 [10.0%], respectively; risk ratio, 1.36; 95% confidence interval, 0.67 to 2.77; P = .40).ConclusionsOur findings indicate that the occurrence of DVT within 7 days after surgery is not significantly different between patients undergoing simultaneous bilateral THA or unilateral THA without any anticoagulant or antiplatelet therapy.Level of evidenceLevel II-III.
| S-EPMC8685905 | biostudies-literature
Project description:BackgroundIncreasing demand for total hip arthroplasty (THA) and rising health-care costs have led hospitals to improve operating room (OR) efficiency. We compare the cost-effectiveness of a simultaneous bilateral THA to that of staged unilateral procedures following the implementation of OR efficiency strategies.MethodsBetween 2017 and 2019, 446 simultaneous and 238 staged bilateral primary THA patients (mean age 61.3 ± 12.0 years; 41.8% males/58.2% females; mean body mass index 27.2 ± 4.8 kg/m2) were treated by a single surgeon using an efficient, standardized workflow for efficient direct anterior approach THA on a standard operating table. There were no differences in inclusion criteria between both groups. From this cohort, 16 simultaneous bilateral THAs and 34 unilateral THAs were prospectively compared for cost-effectiveness using detailed timestamp measurements and data on personnel and material usage. Outcome was assessed based on complication and reoperation rate and patient-reported outcome measures.ResultsThere was a complication rate of 1.2%, without a difference between patients who underwent a simultaneous THA vs those who underwent a staged primary THA (5/446; 1.1% vs 3/238; 1.3% P = .386). The mean OR time (patient in/out and turnover time) was 109.4 ± 19.8 minutes for bilateral THAs and 133.8 ± 12.8 minutes for 2 unilateral THAs (P < .001). An 18% time-saving and 14% cost-saving was achieved per procedure. Sharing 5% of the cost-saving with the surgeon brings benefit to both the hospital and surgeon.ConclusionsImplementing OR efficiency improves cost-effectiveness of simultaneous bilateral THA compared to unilateral procedures. A new value-sharing model could be a solution to align incentives.
| S-EPMC9764026 | biostudies-literature