Increased Complication Risk Associated With Simultaneous Bilateral Total Hip Arthroplasty: A Contemporary, Matched Cohort Analysis

Background: Simultaneous bilateral total hip arthroplasty (sbTHA) continues to be performed in patients who have bilateral end-stage osteoarthritis. However, few studies have evaluated the risk associated with this practice compared to unilateral total hip arthroplasty (THA). Methods: Using a large national database, primary, elective sbTHAs, and unilateral THAs were identified from January 1, 2015 to December 31, 2021. The sbTHAs were matched to unilateral THAs ata 1:5 ratio on age, sex, and pertinent comorbidities. Patient characteristics and comorbidities, and hospital factors were compared between both cohorts. Additionally, 90-day risk of postoperative complications, readmissions, and in-hospital deaths were assessed. After matching, 2,913 sbTHAs were compared to 14,565 unilateral THAs with an average age of 58.5 +/- 10.0 years. Results: Compared to unilateral patients, sbTHA patients demonstrated higher rates of pulmonary em-bolism (PE) (0.4 versus 0.2%, P = .002), acute renal failure (1.2 versus 0.7%, P = .007), acute blood loss anemia (30.4 versus 16.7%, P < .001), and need for transfusion (6.6 versus 1.8%, P < .001). After accounting for confounders, sbTHA patients demonstrated increased risk of PE (adjusted odds ratio [aOR]: 3.76, 95% CI: 1.84 to 7.70, P < .001), acute renal failure (aOR: 1.83, 95% CI: 1.23 to 2.72, P = .003), acute blood loss anemia (aOR: 2.3, 95% CI: 2.10 to 2.53, P < .001), and transfusion (aOR: 4.08, 95% CI: 3.35 to 4.98, P < .001) compared to unilateral THA patients. Conclusion: The practice of performing sbTHA was associated with an increased risk of PE, acute renal failure, and risk of transfusion. Careful evaluation of patient-specific risk factors is warranted when considering these bilateral procedures.

Automated summary

The practice of simultaneous bilateral total hip arthroplasty (sbTHA) is associated with an increased risk of pulmonary embolism, acute renal failure, and need for transfusion compared to unilateral total hip arthroplasty (THA).