Perioperative Complications Following One-Stage Bilateral and Unilateral Total Hip Arthroplasty via Direct Anterior Approach

Background A single stage bilateral total hip arthroplasty utilizing the direct anterior approach has been reported to have a similar incidence of perioperative complications as unilateral total hip arthroplasty.  However, previous studies have included various surgeons with differences in contraindications, protocol, technique and/or experience. Questions/Purposes The purpose of this retrospective review was to compare perioperative outcomes in single-stage bilateral and unilateral total hip arthroplasties via the direct anterior approach performed by a single, fellowship trained, high volume arthroplasty surgeon. Methods A retrospective review was completed on consecutive single-stage bilateral total hip arthroplasties performed between 2009 and 2017 and compared to consecutive unilateral total hip arthroplasties performed between 2014 and 2016.  Perioperative data and complications occurring within 90 days were collected for all included patients.  Student t-tests were performed to detect differences between bilateral and unilateral surgical variables. Results A total of 349 patients (531 hips) were included, consisting of 182 BTHA patients (364 hips) and 167 unilateral THA patients. Patients undergoing unilateral THA had significantly lower operating time, shorter length of stay, lower estimated blood loss, lower rate of transfusions and higher rate of home discharge compared to BTHA (p<0.001). Complications were present in four unilateral THA patients, three requiring revision, and nine BTHA patients, three requiring revision. Conclusions There was no difference in complications, as well as no perioperative mortalities or systemic complications, within 90 days following surgery between unilateral and bilateral patients.  Based on these results, single-stage DAA BTHA is a safe procedure to perform, and did not appear to result in higher rates of complications when compared to patients receiving a DAA unilateral THA.