Simultaneous Bilateral Minimally Invasive Direct Anterior Approach Total Hip Arthroplasty with fast track Protocol

BACKGROUND: Advanced degenerative hip joint disease is bilateral in approximately 20% of cases, prompting questions of whether it is necessary to perform two separate surgical procedures, whether simultaneous bilateral hip replacement makes the surgical treatment too extensive, and whether it significantly affects the postoperative course. MATERIAL AND METHODS: The study analysed the duration of hospitalisation, perioperative complications, and the need for blood transfusion in 30 patients (27 men and 3 women) with bilateral hip osteoarthritis who underwent simultaneous bilateral total hip replacement from a minimally invasive direct anterior approach followed by a fast track protocol for optimisation of perioperative management between 2014 and 2017. The mean age of patients was 60.2 years (range 43 to 77 years) and the mean follow-up period was 28 months (range 18 to 48 months). RESULTS: Mean duration of hospitalisation was 4.5 days (range 3 to 9 days). A total of 4 patients (13%) required allogeneic blood transfusion. No patient developed thromboembolic or infectious complications or implant dislocation after surgery. Apart from one case where the acetabulum was not selected correctly, which resulted in postoperative loosening, there were no other significant medical events potentially related to the surgical treatment. CONCLUSIONS: Simultaneous bilateral total hip arthroplasty using a minimally invasive direct approach and a fast track protocol for optimisation of perioperative management does not increase the need for perioperative blood transfusion or the number of surgical complications and constitutes a safe, effective, and recommendable method of treatment in patients with advanced bilateral degenerative disease of the hip joints.