Introduction

What is a hip replacement?

A total hip replacement (THR) is a surgical procedure in which the natural hip joint is completely replaced with an artificial joint. This surgery is often performed on patients suffering from severe osteoarthritis, rheumatoid arthritis, or other degenerative diseases of the hip joint that cause severe pain and limited mobility. A THR can significantly improve quality of life by reducing pain and restoring mobility.

Why bilateral hip replacements?

In some patients, both hip joints (bilateral) are severely affected. In such cases, a bilateral total hip replacement (THR) can be a sensible solution. This can be performed either in a single operation (simultaneous) or in two separate procedures (sequential). A bilateral THR in one operation can shorten the overall recovery time and lead to an improved quality of life, as both hip joints are treated at the same time.

Preparation for a bilateral hip replacement in one operation

Medical assessment and diagnostics

Before a bilateral hip replacement is considered, extensive medical examinations must be carried out. These include:

• X-rays: To assess the condition of the hip joints and to plan the procedure.
• MRI: Can provide additional details, especially in complex cases.
• Blood tests: To check general health and to prepare for surgery.
• ECG and cardiac examinations: To ensure that the patient's heart is strong enough for the operation.

Preoperative planning

Preoperative planning is crucial for the success of the surgery. This includes selecting the correct prosthesis types and sizes, as well as determining the surgical approach. In many cases, a minimally invasive approach is preferred to shorten recovery time and minimize the risk of complications. The steps of preoperative planning include:

• Prosthesis selection: There are various types of hip prostheses, including cemented and cementless prostheses. The selection depends on several factors, including the patient's age, bone density, and overall health.
• Planning the surgical approach: The surgical approach can vary from patient to patient. The minimally invasive approach has the advantage of damaging less tissue, which can shorten the recovery time.
• Patient education: The patient must be fully informed about the procedure, the risks, the benefits and the postoperative course.

Performance of bilateral hip replacement

Simultaneous vs. sequential operation

A bilateral hip replacement can be performed either simultaneously or sequentially:

• Simultaneous surgery: Both hip joints are replaced in a single operation. This can shorten the overall recovery time and reduce the number of hospital stays. However, it also carries a higher risk of complications and requires a longer anesthesia time.
• Sequential surgery: The hips are replaced in two separate operations, usually several months apart. This can be safer and reduce the risk of complications, but requires a longer overall recovery time and more hospital stays.

Surgical techniques

The surgical techniques for bilateral hip replacement are similar to those for unilateral hip replacement; however, the surgeon must proceed with particular care to minimize the risk of complications. These techniques include:

• Minimally invasive anterolateral approach (ALMIS): This approach carries a lower risk of dislocations and allows for a quick recovery, but requires more experience from the surgeon.
• Minimally invasive anterior approach (AMIS): This minimally invasive approach has the advantage of faster recovery, but often requires special equipment and experience.

Aftercare and rehabilitation

Early postoperative phase

Immediately after surgery, monitoring in the hospital is crucial. Patients receive pain medication and thrombosis prophylaxis to reduce the risk of blood clots. The first steps of aftercare include:

• Pain control: Painkillers are administered to relieve postoperative pain.
• Thrombosis prophylaxis: Anticoagulants are administered to reduce the risk of blood clots.
• Physiotherapy: Patients begin physiotherapy the day after surgery to improve mobility and strengthen muscles.

rehabilitation

Intensive rehabilitation is crucial for a successful recovery. This includes physiotherapy, gait training, and muscle strengthening. Most patients can begin rehabilitation within a few weeks of surgery. Rehabilitation measures include:

• Physiotherapy: An individually tailored physiotherapy program is crucial for restoring mobility and strength.
• Gait training: Patients learn to walk with crutches or a walking stick to reduce the strain on the new hip joints.
• Muscle strengthening: Exercises to strengthen the muscles around the hip joint are important to improve stability and reduce the risk of complications.

Long-term follow-up care

Long-term follow-up examinations are important to monitor the condition of the prostheses and ensure that no complications arise. This includes regular X-rays and clinical assessments. Long-term follow-up measures include:

• Regular check-ups: These serve to check the condition of the prostheses and to monitor the healing process.
• Lifelong follow-up care: Patients should visit their orthopedist regularly to ensure that the prostheses are functioning correctly and that no complications arise.
• Activity adjustments: Patients should learn which activities to avoid in order to maximize the lifespan of their prostheses.

Advantages of a bilateral hip replacement in one operation

1. Reduced overall recovery time

Simultaneous healing

A significant advantage of performing both hip replacements simultaneously is the shortened overall recovery time. Since both hip joints are operated on in a single procedure, the patient can go through the entire healing process at the same time, leading to a faster return to mobility.

Reduced hospital stays

One operation also means only one hospital stay compared to two separate procedures. This not only reduces the burden on the patient, but also the overall costs and the strain on the healthcare system.

2. Improved quality of life

Unique pain relief

Patients often report significant pain relief after bilateral hip replacement. Because both painful hip joints are replaced simultaneously, patients experience a more comprehensive and immediate improvement in their quality of life.

Uniform Rehabilitation

With a bilateral hip replacement, patients can undergo a single, unified rehabilitation phase, which facilitates physical therapy and the recovery of walking ability. Coordinating a single rehabilitation therapy for both hips can be more efficient and effective.

3. Economic advantages

Cost efficiency

Although a bilateral total hip replacement may initially be more expensive in a single operation, it leads to cost savings in the long run. The overall costs for hospital stays, rehabilitation, and postoperative care can be reduced by combining the procedures.

Less absenteeism

For working patients, a shorter overall recovery time also means less time off work. This can be a great advantage for the patient's job security and financial situation.

4. Psychological advantages

Reduced anxiety and stress

Undergoing a single surgical procedure reduces psychological stress compared to two separate operations. Patients only have to prepare for surgery and the associated anxieties and uncertainties once.

Continuous support

Continuous postoperative care after a single surgery can also be psychologically beneficial. Patients can focus on a single recovery process, which often leads to a more positive overall outcome.

Risks of a double hip replacement

Operational risks

Although the benefits are considerable, it is important to consider the risks as well. Performing both hip replacements simultaneously can prolong the surgery time and increase the risk of complications such as blood loss, infection, and thrombosis.

Anesthesia risks

A longer anesthesia time can pose additional risks, especially in elderly patients or those with pre-existing health problems. Therefore, a careful preoperative assessment is essential.

Postoperative challenges

Postoperative rehabilitation can be more intensive and demanding because both hips are affected simultaneously. This necessitates a comprehensive and well-planned rehabilitation strategy to achieve the best possible outcomes. Postoperative care and rehabilitation are more intensive after bilateral total hip replacement and require greater commitment from both the healthcare provider and the patient.

Long-term outlook

Lifespan of the prostheses

Modern hip replacements have a lifespan of 15 to 20 years or more. In the case of bilateral total hip replacement (THR), the long-term durability of the prostheses is an important aspect that must be considered. Factors that can influence the lifespan of the prostheses include:

• Activity level: Patients should avoid activities that could put excessive strain on the prostheses.
• Weight control: Being overweight can increase the strain on prostheses and shorten their lifespan.
• Regular follow-up care: Regular check-ups are important to monitor the condition of the prostheses and to take early action if problems occur.

quality of life

Studies have shown that patients with bilateral total hip replacement experience a significant improvement in their quality of life. Pain reduction and restoration of mobility are crucial factors that contribute to overall satisfaction. Long-term benefits include:

• Pain relief: Most patients report a significant reduction or complete elimination of pain.
• Improved mobility: Restoring mobility allows patients to lead an active life and participate in activities they were previously unable to do due to their hip problems.

Conclusion

A bilateral total hip replacement (THR) performed in a single operation offers numerous advantages, including a shorter overall recovery time, improved quality of life, cost savings, and psychological benefits. Despite the associated risks and challenges, this surgical option can be the optimal solution for many patients. Careful planning and individualized assessment can achieve the best results and significantly improve patients' quality of life. A bilateral THR can therefore be a life-changing decision for patients with severe hip problems. Although a bilateral THR in a single operation carries certain risks, the benefits often outweigh them, especially when performed by experienced surgeons and with thorough postoperative care. If you or a loved one is considering a bilateral THR in a single operation, it is important to gather comprehensive information and carefully weigh all options. Speak with Prof. Kutzner at the ENDOPROTHETICUM to discuss your specific needs and the best approach for your situation.