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Low complication rates, excellent clinical outcomes observed with anterior approach THA
Recently published findings demonstrated low rates of perioperative complications and excellent clinical outcomes were observed in patients who underwent simultaneous bilateral anterior approach total hip arthroplasty.
Researchers retrospectively reviewed data for 75 patients (150 hips) who underwent simultaneous bilateral anterior approach total hip arthroplasty (THA) from July 2007 to December 2011. Mean operative time was 144 minutes. All patients received same postoperative care, including routine perioperative prophylactic antibiotics and an intraoperative reservoir suction drain, and patients were given permission for full weight bearing immediately after surgery. Patients were evaluated postoperatively at 6 weeks, 3 months, 1 year and annually, at which times, postoperative pain, functional status and complications were recorded and postoperative radiographs were reviewed. Mean follow-up was 26 months.
The researchers collected data pertaining to the patients’ age, gender, race, BMI, diagnosis, preoperative pain level and Harris Hip Score (HHS). Variables including operative time, estimated blood loss, procedure-related fractures, actual postoperative blood loss from drains, transfusion rate, ambulation distance by postoperative day, hospital length of stay, discharge location, venous thromboembolic event, infection, hematoma, wound complications, nerve palsy, aseptic loosening, dislocation, readmission to hospital, postoperative pain, HHS and death were also reviewed. Additionally, patients’ pain was rated using a zero to 10 verbal numerical scale.
Results showed mean blood loss was 565 mL. Sixty-two patients required a blood transfusion postoperative, and 13 did not require a blood transfusion. According to the researchers, the number of units of transfused blood per patient decreased over time, with an average number of units per patient among the first 25 patients of 2.6 units, compared with an average 1.6 units per patient in the remaining 50 patients.
Thirty-seven patients had no pain at postoperative day 1, whereas 28 reported mild pain, 10 reported moderate pain and no patients reported severe pain. The mean length of patients’ hospital stay was 2.75 days, with 51 patients discharged home and 24 patients sent to a skilled nursing or acute rehabilitation facility.
At the time of the final follow-up, all patients returned to activity at a preoperative level or higher, according to the researchers. Out of all the patients studied, 19 performed at a higher activity level compared with preoperative activity levels. Additionally, HHS scores increased from an average preoperative score of 49.8 to an average score of 97.8 postoperatively.
By 30 days postoperatively, no readmissions had occurred. No infections, nerve palsy, fractures, aseptic loosening, dislocation, reoperations or death occurred were reported at the final follow-up, according to the researchers. ‒ by Monica Jaramillo
Disclosures: Gondusky reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
Perspective
Back to TopThe authors should be complimented for their efforts to collect more data on bilateral anterior approach total hip arthroplasty (THA) done in a simultaneous fashion. The results do seem to indicate that this can be done with an acceptable complication rate and an excellent 30-day readmission performance. It would obviously be nice to be able to compare this patient cohort to another group of patients undergoing bilateral THA with a staged approach within the same, experienced orthopedic practice. One would assume the greatest difference would be seen with the transfusion rate and associated elevated blood levels. Nonetheless, the authors have retrospectively collected data that demonstrates a relatively low complication rate if the need for transfusion is excluded. It remains critical for surgeons to discuss the potential risks and benefits of a bilateral simultaneous approach with the patient in the preoperative setting.
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Gondusky JS, et al. Orthopedics. 2015;doi:10.3928/01477447-20150701-60.