Postoperative Complications and Cost-effectiveness of Simultaneous and Staged Bilateral Total Hip Arthroplasty Using a Modified Minimally Invasive Two-incision Technique

PURPOSE To compare the postoperative complications and cost-effectiveness of simultaneous and staged bilateral total hip arthroplasty (THA), using a minimally invasive two-incision technique. MATERIALS AND METHODS All 206 patients who underwent simultaneous or staged bilateral THA using a modified, minimally invasive two-incision between January 2004 and November 2009 were registered and divided into a simultaneous bilateral THA group (group A, 147 patients) and staged bilateral THA group (group B: 59 patients). Staged THA was performed on group B with interval of at least 2 months between the initial and second surgery. Clinical evaluations, amount of blood loss, need for transfusion, complications and costeffectiveness were compared. RESULTS Perioperative morbidity rates were similar in the two groups (P=0.546) and overall complications were not significant between the groups. Average length of hospital stay was significantly shorter in group A than in group B (average 14.6 days vs. 25.3 days; P<0.001). Total medical cost was significantly higher in group B than in group A (average 9,236 US dollars vs. 11,163 US dollars). Patients in group A required more blood transfusions than those in group B (3.02 vs. 1.90 units; P=0.003), although blood loss in the two groups were similar (892 vs. 917 ml P=0.613). CONCLUSION Comparison of intra- and postoperative complications support the conclusion that simultaneous bilateral THA compares favorably with staged THA in terms of outcomes, complications and cost-effectiveness.