One stage bilateral total hip arthroplasty with direct anterior approach and fast-track protocols: A prospective study

Background: Simultaneous bilateral total hip arthroplasty could represent a reasonable option in patients affected by end-stage bilateral arthritis of the hip. One-stage bilateral total hip arthroplasty (1-SBTHA) includes a single hospital stay, a shorter rehabilitation time, and decreased management costs per patient. However, there are concerns regarding the possible increase of intraoperative e postoperative complications. The purpose of this study was to investigate whether the advantages associated with the direct anterior approach (DAA) in combination with the application of Enhanced Recovery After Surgery (ERAS) pathway, could ensure the efficacy and safety of simultaneous bilateral total hip arthroplasty (THA). Method: A prospective single centre clinical study was conducted on 46 patients (30 men and 16 women) who underwent one-stage bilateral THA through the DAA between May 2019 and March 2023 at our institution. The mean age was 61.8 years (range 50 to 74 years) and the mean last follow-up was 6 months (range 5 to 7 months). Hospital length of stay, surgical time, blood transfusions and complications were documented. Functional outcomes and pain were assessed using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Oxford Hip Score (OHS), Forgotten Joint Score (FJS) and Numeric Pain Rating Scale (NRS). Results: The mean hospital length of stay was 6.4 days (range 5 to 10 days), and the mean surgery time was 135.5 minutes (range 86 to 185 minutes). Mean blood Hb levels were 14.5 ± 1.1 g/dL before the surgery and 10.4 ± 1.0 g/dL 72 hours after the surgery. Only 8 patients (17.4%) received allogenic blood transfusion. No perioperative deaths were recorded. No thromboembolism or other systemic complications occurred. The functional and pain scores improved statistically from preoperatively to the last follow-up. Conclusions: Our results suggest that simultaneous bilateral THA performed using a tissue-sparing approach (DAA) and a fast-track pathway for optimisation of perioperative management with multidisciplinary approaches, can be considered a safe and effective method of treatment in well selected patients with severe bilateral hip arthritis