Introduction

What is a total hip replacement?

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

Why bilateral hip prostheses?

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

Preparation for bilateral hip replacement surgery

Medical evaluation and diagnostics

Before considering bilateral total hip replacement, extensive medical examinations must be performed. These include:

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

Preoperative planning

Preoperative planning is crucial for the success of the operation. 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 healing time and minimize the risk of complications. Preoperative planning steps include:

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

Performing bilateral hip replacement surgery

Simultaneous vs. sequential surgery

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

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

Surgical techniques

The surgical techniques for bilateral THA are similar to unilateral THA, but the surgeon must take special care to minimize the risk of complications. Techniques include:

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

Aftercare and rehabilitation

Early postoperative period

Immediately after surgery, hospital monitoring is crucial. Patients are given painkillers and thrombosis prophylaxis to reduce the risk of blood clots. The first steps of aftercare include:

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

rehabilitation

Intensive rehabilitation is crucial for a successful recovery. This includes physical therapy, walking exercises, 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.
• Walking training: Patients learn to walk with crutches or a cane to reduce stress 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 aftercare

Long-term follow-up visits 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 are used to check the condition of the prostheses and monitor healing.
• Lifelong follow-up care: Patients should see their orthopedist regularly to ensure that the prostheses are functioning properly and that no complications arise.
• Activity Adjustments: Patients should learn what activities they should avoid to maximize the life of the dentures.

Advantages of bilateral total hip replacement in one operation

1. Reduced overall recovery time

Simultaneous healing

A significant advantage of performing both THAs at the same time is the reduced overall recovery time. Because both hip joints are operated on in a single procedure, the patient can go through the entire healing process at the same time, resulting in faster recovery of mobility.

Reduced hospital stays

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

2. Improved quality of life

Unique pain management

Patients often report experiencing significant pain relief after bilateral THA. Because both painful hip joints are replaced at the same time, patients experience a more comprehensive and immediate improvement in their quality of life.

Unified rehabilitation

With bilateral total hip replacement, patients can go through a consistent rehabilitation phase, making physical therapy and regaining walking ability easier. Coordinating a one-time rehab therapy for both hips can be more efficient and effective.

3. Economic benefits

Cost efficiency

Although bilateral total hip replacement surgery may initially be more expensive, it results in cost savings in the long term. The overall costs of hospital stays, rehabilitation measures and postoperative care can be reduced by combining the procedures.

Less loss of work

For working patients, a shorter overall recovery time also means less time off work. This can be of great benefit to the patient's professional stability and financial situation.

4. Psychological benefits

Reduced anxiety and stress

Going through a single surgical procedure reduces psychological stress compared to two separate surgeries. Patients only have to prepare for an operation and the associated fears and uncertainties once.

Continuous support

Continuing postoperative care after a single operation 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 significant, it is important to also consider the risks. Performing both THAs at the same time can prolong the operation time and increase the risk of complications such as blood loss, infection and thrombosis.

Anesthesia risks

Prolonged anesthesia time may pose additional risks, particularly in older patients or those with existing health problems. Therefore, careful preoperative evaluation is essential.

Postoperative challenges

Postoperative rehabilitation can be more intense and demanding because both hips are affected at the same time. This requires a comprehensive and well-planned rehabilitation strategy to achieve the best possible results. Postoperative care and rehabilitation are more intensive for bilateral total hip replacement and require more commitment from the practitioner and the patient.

Long-term prospects

Lifespan of the prostheses

Modern hip replacements have a lifespan of 15 to 20 years or more. When it comes to bilateral total hip replacement, the long-term durability of the prostheses is an important aspect that must be taken into account. Factors that can affect the lifespan of dentures include:

• Activity Level: Patients should avoid activities that could place undue stress on the prostheses.
• Weight control: Excess weight can increase the strain on dentures and shorten their lifespan.
• Regular follow-up care: Regular check-ups are important to monitor the condition of the dentures and take early action if problems arise.

life quality

Studies have shown that patients with bilateral total hip replacement experience a significant improvement in quality of life. Reducing pain and restoring 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 return to active lives and participate in activities that they were previously unable to do due to their hip problems.

Conclusion

Bilateral THA in one operation offers numerous benefits, including reduced overall recovery time, improved quality of life, economic savings, and psychological benefits. Despite the risks and challenges involved, this surgical option may represent an optimal solution for many patients. Careful planning and individual assessment can achieve the best results and significantly improve patients' quality of life. A bilateral total hip replacement can be a life-changing decision for patients with severe hip problems. Although double total hip replacement surgery involves certain risks, the benefits often outweigh the risks, especially when performed by experienced surgeons and with thorough postoperative care. If you or a loved one are considering bilateral total hip replacement surgery, it is important to obtain comprehensive information and carefully weigh all options. Talk to Prof. Kutzner at ENDOPROTHETICUM about your specific needs and the best approach for your situation.