Bilateral one-stage total hip replacement in rheumatoid arthritis and SPA

The safety and efficacy of bilateral simultaneous total hip replacement: an analysis of 2063 cases

Comparison of the safety and efficacy of bilateral simultaneous total hip replacement (THR) and that of staged bilateral THR and unilateral THR was conducted using DerSimonian-Laird heterogeneity meta-analysis. A review of the English-language literature identified 23 citations eligible for inclusion. A total of 2063 bilateral simultaneous THR patients were identified. Meta-analysis of homogeneous data revealed no statistically significant differences in the rates of thromboembolic events (p = 0.268 and p = 0.365) and dislocation (p = 0.877) when comparing staged or unilateral with bilateral simultaneous THR procedures. A systematic analysis of heterogeneous data demonstrated that the mean length of hospital stay was shorter after bilateral simultaneous THR. Higher blood transfusion requirements were expected following bilateral simultaneous THR than staged or unilateral THR, and surgical time was not different between groups. This procedure was also found to be economically and functionally efficacious when performed by experienced surgeons in specialist centres.

Joint surgery in severe ankylosing spondylitis

Twenty-three patients with ankylosing spondylitis with severe deformities of hips, knees, and ankles were treated by a variety of surgical procedures followed by a comprehensive rehabilitation program. The surgery included 35 total hip replacements, six knee arthroplasties, and seven femoral osteotomies. Elongation of the Achilles tendon (eight procedures) was done on 6 patients. Shortening of the femur was performed in patients with long-standing flexion contractures when straightening of the limb during the operation caused traction on the vessels and the nerves. When there was both hip and knee involvement, hip arthroplasty was performed first. Preoperative planning aimed at obtaining plantigrade position of the feet and lower limb-length equality. Availability of custom-made and miniaturized components was essential. Positioning of patients on the operating table necessitated special supports. Six patients were completely bedridden before surgery and 17 were severely disabled or deformed. All the patients but 2 improved markedly, became mobile, independent, and self-supporting. Revision arthroplasty was performed in 4 patients; 3 others deteriorated functionally, but refused further treatment. Heterotopic bone formation was observed after operation in 6 patients. Surgery for severe ankylosing spondyloarthritis requires highly specialized and well-equipped centers.