Published: 2020-02-25

Functional outcomes and complications of simultaneous bilateral total hip arthroplasty in Asian population

Ram Prasad Meena, Utsav Shetty, Sadaram Bhishnoi, Ramkhiladi Meena


Background: Total hip arthroplasty (THA) is one of the most successful and cost-benefit surgical treatments. However, there are concerns about the safety of the procedure and higher complications. We aimed to evaluate the complications and outcomes of one-stage bilateral total hip arthroplasty (BTHA) with anterolateral approach.

Methods: A total of 24 patients from February 2014 to October 2019 underwent BTHA in Government Medical College and Attached Group of Hospitals, Kota. A prospective analysis of the functional outcomes and complications was performed. All surgeries were performed via anterolateral approach. All patients were followed up till 1.5 years post-operative.

Results: During period of study 16 men and 8 women with a mean age of 40.12±2.52 years at the time of presentation were entered. The mean surgical time was 112±6 mins. The mean hospital stay was 7 days. Hemoglobin level decreased significantly after operation (p=0.046) mean of 10.83±0.3 mg/dl. There was no reported patient with perioperative death, deep venous thrombosis, pulmonary embolism, infection, dislocation, periprosthetic fracture or heterotrophic ossification. The mean preoperative MHHS score was 45.93±5.33 in patients. MHHS score improved to 92.06±2.47 in the last follow-up (p=0.0001).

Conclusions: Our results recommend the use of one-stage BTHA through anterolateral approach in cases indicating bilateral THA without increase in rate of complications. Functional and clinical outcomes are comparable and hospital stay is significantly shorter.


One stage bilateral total hip arthroplasty, Clinical outcome, Complication

Full Text:



Ritter MA, Randolph JC. Bilateral total hip arthroplasty: a simultaneous procedure. Acta Orthop Scand. 1976;47:203-8.

Salvati EA, Hughes P, Lachiewicz P. Bilateral total hip-replacement arthroplasty in one stage. J Bone Joint Surg [Am]. 1978;60-A:640-4.

Ritter MA, Stringer EA. Bilateral total hip arthroplasty: a single procedure. Clin Orthop 1980;149:185-90.

Camissa FPJ, O’Brien SJ, Salvati EA, Sculco TP, Wilson PD Jr, Ranawat CS, et al. One-stage bilateral total hip arthroplasty: a prospective study of perioperative morbidity. Orthop Clin North Am. 1988;19:657-68.

Wykman A, Olsson E. Walking ability after total hip replacement: a comparison of gait analysis in unilateral and bilateral cases. J Bone Joint Surg [Br]. 1992;74-B:53-6.

Shih CH, Ho WB. One-stage versus two-stage bilateral autophor ceramic total hip arthroplasty. Clin Orthop. 1985;193:141-5.

Wilson PD, Amstutz HC, Czerniecki A, Salvati EA, Mendes DG. Total hip replacement with fixation by acrylic cement. A preliminary study of 100 consecutive McKee-Farrar prosthetic replacements. J Bone Joint Surg Am. 1972;54(2):207-36.

Wamper KE, Sierevelt IN, Poolman RW, Bhandari M, Haverkamp D. The Harris hip score: Do ceiling effects limit its usefulness in orthopedics: A systematic review. Acta Orthopaedica. 2010;81:703-7.

Sivananthan S, Arif M, Choon DS. Small stem Exeter total hip replacement: clinical and radiological follow-up over a minimum of 2.5 years. J orthop Surg. 2003;11:148-53.

Brooker AF, Bowerman JW, Robinson RA, Riley LH Jr. Ectopic ossification following total hip replacement: incidence and a method of classification. J Bone Joint Surg [Am]. 1973;55(A):1629-32.

Bhan S, Pankaj A, Malhotra R. One- or two-stage bilateral Total Hip Arthoplasty. J Bone Joint Surg (Br). 2006;88B:298-303.

Adrian AJ, Bayona F, Rech JA, Murray DW. One or two-stage bilateral total hip replacement. J Arthroplasty. 1999;14:439-45.

Lindberg L, Sjostrand LO. The future needs of hip surgery. Prognosis for Lund 1972–1980. Lakartidningen. 1972;69:4109–12.

Ritter MA, Vaughan RB. Ectopic ossification after total hip arthroplasty: predisposing factors, frequency, and effect on results. J Bone Joint Surg [Am]. 1977;59:345-51.

Johnston LR, Clift BA, Abboud RJ. Bilateral Simultaneous Hip Replacement Versus Bilateral Sequential Hip Replacement: A 7-Year Data Review. Orthop Nurse. 2011;30(2):119-23.

Huotari K, Lyytikainen O, Seitsalo S. Patient outcomes after simultaneous bilateral total hip and knee joint replacements. J Hosp Infect. 2007;65:219-25.

Bracy D, Wroblewski BM. Bilateral Charnley arthroplasty as a single procedure. A report on 400 patients. J Bone Joint Surg Br. 1981;63:354–46.

Otte KS, Husted H, Orsnes T, Kehlet H. Bilateral simultaneous total hip arthroplasty in a fast track setting. Hip Int. 2011;21:336–9.

Berend KR, Lombardi AV, Adams JB. Simultaneous vs staged cementless bilateral total hip arthroplasty: perioperative risk comparison. J Arthroplasty. 2007;22:111-5.

Berend ME, Ritter MA, Harty LD, Davis KE, Keating EM, Meding JB, et al. Simultaneous bilateral versus unilateral total hip arthroplasty an outcomes analysis. J Arthroplasty. 2005;20:421–6.

Lindberg L, Sjostrand LO. The future needs of hip surgery. Prognosis for Lund [1972–1980]. Lakartidningen. 1972;69:4109–12.

Kuoppala J, Lamminpaa A. Rehabilitation and work ability: a systematic literature review. J Rehabil Med. 2008;40:796-804.