Bilateral Total Hip Arthroplasty: Outcomes of Staged Versus Simultaneous Procedures Performed Using an Anterior-Based Muscle-Sparing Approach.

BACKGROUND: The incidence of total hip arthroplasty (THA) in the United States continues to increase due to its ability to markedly improve patients' quality of life. This study investigated and compared the perioperative and postoperative outcomes of simultaneous (SI-THA) and staged (ST-THA) bilateral THA procedures using an anterior-based muscle-sparing (ABMS) approach. METHODS: This retrospective case control study evaluated perioperative and postoperative outcomes from primary bilateral SI-THA or ST-THA (within 365 days) performed with the ABMS approach by 3 surgeons at a single institution between January 2013 and August 2020. A total of 226 patients (113 in each cohort) were matched based on age, sex, body mass index, and comorbidity score. RESULTS: Compared to the ST-THA group, the SI-THA had shorter anesthesia duration (P < .001) and shorter length of stay (P < .001), but longer length of surgery (P = .002). There was no statistical significance between groups in blood transfusion rates, discharge dispositions, emergency department visits, hospital readmissions, or postoperative complications within one year. CONCLUSIONS: The results of this study demonstrate that SI-THA and ST-THA yield comparable results using the ABMS approach. Our perioperative and postoperative results suggest low rates of complications, emergency department visits, readmissions, and high rates of patient satisfaction scores. Therefore, both SI-THA and ST-THA can be considered by experienced surgeons as treatment for advanced bilateral hip arthritis.

The ABLE Anterior-Based Muscle-Sparing Approach: A Safe and Effective Option for Total Hip Arthroplasty.

Background: The direct anterior and posterior approaches are well-researched options in total hip arthroplasty (THA). The less-studied anterior-based muscle-sparing approach, also known as the ABLE advanced anterior approach, centers on minimizing surgical trauma and medical costs while maintaining or improving patient outcomes. Material and methods: THAs performed using the ABLE approach by 3 surgeons at a single institution between January 2013 and August 2020 were retrospectively assessed for outcomes pertaining to safety and performance intraoperatively, perioperatively, and postoperatively. Additionally, intraoperative and postoperative complications were evaluated, and patient-reported outcome measures and radiographic outcomes out to 1-year follow-up. Results: There were 6251 THAs (5433 patients) eligible for inclusion. The mean surgical time was 65 minutes, mean intraoperative blood loss was 204 mL, and the transfusion rate was 0.5%. Patients had a mean length of stay of 1.4 days. Overall, 93.4% of patients were discharged home, 1.9% visited the emergency department within 30 days, and 2.9% had an unplanned readmission to the hospital within 90 days. The overall major surgical complication rate was 1.18%, with a dislocation rate of 0.13%, a deep infection rate of 0.19%, and a postoperative periprosthetic fracture rate of 0.37%. Conclusions: The minimally invasive ABLE approach is a safe and effective surgical approach for patients undergoing THA. It can be performed efficiently and with limited complications, making it an appealing option for surgeons to utilize during this era of value-based care.