Comparison of outcomes and cost-effectiveness of simultaneous and staged total hip arthroplasty using the anterolateral-supine approach.

Background: To date, no study has compared simultaneous bilateral total hip arthroplasty (simBTHA) with staged BTHA (stgBTHA) using the anterolateral-supine approach (ALSA). This study compared the outcomes and cost-effectiveness of simBTHA and stgBTHA using ALSA.

Methods: This retrospective cohort study was conducted on patients who required bilateral ALSA THA at the time of their initial medical evaluation between August 2015 and January 2023. Patients were divided into two groups: simBTHA and stgBTHA. Demographic data, including age, sex, body mass index (BMI), and American Society of Anesthesiologists Physical Status (ASA-PS) scores, were collected. Operative outcomes such as surgical time, blood loss, autologous and allogeneic blood transfusions, and time to ambulation were compared. Clinical outcomes were assessed using the Japanese Orthopaedic Association (JOA) hip score, Japanese Orthopaedic Association Hip-disease Evaluation Questionnaire (JHEQ), and Forgotten Joint score-12 (FJS-12). Postoperative complications, revisions, readmissions, and mortality within 90 days were also recorded. The total cost, length of stay (LOS), and time interval between surgeries in the stgBTHA group were analyzed.

Results: A total of 129 patients were included: 104 in the simBTHA group and 25 in the stgBTHA group. The preoperative ASA-PS significantly differed between the two groups (P < 0.01), but other demographic data were not significantly different. The simBTHA group had significantly shorter surgical times (156 min) compared to the stgBTHA group (175 min) (p = 0.02). Blood loss was similar between the two groups (670 mL for simBTHA and 629 mL for stgBTHA). There were no significant differences in the time to ambulation, postoperative complications, or clinical outcomes between the two groups. However, the simBTHA group had a significantly lower total cost (83.2%, p < 0.01) and shorter LOS (20.5 days) compared to the stgBTHA group (30 days) (p < 0.01). No significant differences in complication rates, revisions, or readmissions were observed between the groups.

Conclusions: SimBTHA with ALSA provides comparable clinical outcomes to stgBTHA while offering significant advantages in terms of reduced costs and shorter hospital stays. For patients with suitable health conditions, simBTHA is a preferable choice due to its faster recovery and greater cost-effectiveness.