Short-term outcomes of one-stage bilateral total hip arthroplasty in a South African setting
Keywords:one-stage bilateral total hip arthroplasty, two-stage bilateral total hip arthroplasty, bilateral total hip arthroplasty, bilateral osteonecrosis of the femoral head
Background; Total hip arthroplasty (THA) is one of the most successful orthopaedic surgical procedures that dramatically improves function, pain relief and quality of life for the patient. In South Africa, we have a high prevalence of osteonecrosis of the femoral head (ONFH) and inflammatory arthropathy affecting a young population. This subgroup of patients is usually between the ages of 30 and 50 years (young) and they require bilateral total hip replacements (BTHA) to allow them to return to their previous level of function and employment. The study aimed to assess the short-term outcomes and complications in patients with bilateral hip pathology managed surgically with a one-stage BTHA.
Methods: We retrospectively reviewed a series of 33 patients who underwent a one-stage BTHA at a high-volume arthroplasty unit in a central hospital in South Africa between January 2016 and December 2018. The mean age was 38 years (standard deviation [SD] 9 years), and the most common diagnosis was ONFH (76%). In this cohort, 12 patients (36%) tested HIV positive. We assessed patient folders for diagnosis, perioperative details, postoperative follow-up and complications. Radiographic analysis was also performed.
Results: There were no revisions or planned surgical interventions for any of the patients at a median follow-up of 22 months (interquartile range [IQR] 11–45 months). Thirty patients reported no hip pain and walked unaided at their most recent follow-up visit. Two patients reported groin pain and continued to walk with a single crutch. One patient demised from unrelated causes approximately one year post-surgery. The only perioperative complication was a urinary tract infection (UTI) in one patient. The median postoperative length of stay was six days (IQR 4–7 days), and no other medical or surgical complications were reported. Radiographic analysis revealed four patients (12%) with Brooker grade 1 heterotopic ossification in six hips.
Conclusion: Our results suggest that surgical treatment with a one-stage BTHA is a good alternative to a two-stage BTHA when performed in a high-volume arthroplasty centre and carefully selected patients. The 30-day mortality rate was 0%, and the complication rate was low.
Level of evidence: Level 4