Simultaneous versus staged-bilateral THA using a piriformis-preserving minimally-invasive posterolateral approach

Objectives: There is still debate regarding the rationale for 1-stage bilateral total hip arthroplasty (THA). We aimed to compare re-admissions, adverse events, and total length of stay in patients with simultaneous bilateral versus staged THA. Materials and methods: We identified 166 patients who underwent bilateral THA. They were matched based on sex, preoperative haemoglobin and the time interval between surgeries. A cohort of 84 simultaneous bilateral THA was compared to 82 staged bilateral THA. Median follow-up was 64.5 months. Results: Logistic regression showed that type of surgery was not associated with risk of complication. No significant differences were observed between simultaneous and staged bilateral THA in terms of short-term or long-term adverse events (OR 0.76; 95% CI, 0.31–1.85; p = 0.558; and OR 1.32; 95% CI, 0.27–6.42; p = 0.728, respectively). Similarly, surgical strategy was not associated with risk of re-admission ( p = 0.606). Staged bilateral THA was significantly associated with total length of stay (LOS), with an average increase of 2.00 days compared to simultaneous procedures (Coefficient 2.00; 95% CI, 1.36–2.64; p < 0.001). Conclusions: In this matched-cohort study, single-anaesthetic bilateral THA was not associated with an increased risk of adverse events and re-admissions, suggesting it is a safe procedure, while decreasing operating room time, length of stay and anaesthesia-related risks.