title: A retrospective analysis of the merits and challenges associated with simultaneous bilateral THA using the direct anterior approach.
abstract: BACKGROUND
  15%-20% of patients presenting for total hip arthroplasty (THA) have bilateral disease. While simultaneous bilateral THA is of interest to patients and surgeons, debate persists regarding its merits. The majority of previous reports on simultaneous bilateral THA involve patients in the lateral decubitus position, which require repositioning, prepping and draping, and exposure of a fresh wound to pressure and manipulation for the contralateral THA. The purpose of this study was to compare complications, component position, and financial parameters for simultaneous versus staged bilateral THAs using the direct anterior approach (DAA).
  
  
  METHODS
  Medical records were reviewed for patient demographics, medical history, operative time, estimated blood loss (EBL), change in hemoglobin, transfusion, tranexamic acid (TXA) use, length of stay (LOS), discharge disposition, leg length discrepancy, acetabular cup position, and perioperative complications. Cost and reimbursement data were analysed.
  
  
  RESULTS
  44 patients were included in the sequential group and fifteen patients in the simultaneous group. Operative time, EBL, hemoglobin drop, transfusion rate, and LOS were significantly increased for simultaneous group. There was no significant difference in component position, complications, or readmissions between groups. Profit per hip was significantly higher for the simultaneous group.
  
  
  CONCLUSIONS
  While simultaneous DAA THA presents challenges, our results suggest that simultaneous DAA THA may add value to the healthcare system without resulting in increased complications compared to sequential hip arthroplasty.
authors.affiliation: Department of Orthopaedic Surgery, Wake Forest University Baptist Medical Center, Winston-Salem - USA.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Brown
authors.affiliation: Department of Orthopaedic Surgery, Wake Forest University Baptist Medical Center, Winston-Salem - USA.
authors.forename: Johannes F
authors.initials: JF
authors.lastname: Plate
authors.affiliation: Department of Orthopaedic Surgery, Wake Forest University Baptist Medical Center, Winston-Salem - USA.
authors.forename: David C
authors.initials: DC
authors.lastname: Holst
authors.affiliation: Department of Orthopaedic Surgery, Wake Forest University Baptist Medical Center, Winston-Salem - USA.
authors.forename: Daniel N
authors.initials: DN
authors.lastname: Bracey
authors.affiliation: Department of Orthopaedic Surgery, Wake Forest University Baptist Medical Center, Winston-Salem - USA.
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Bullock
authors.affiliation: Department of Orthopaedic Surgery, Wake Forest University Baptist Medical Center, Winston-Salem - USA.
authors.forename: Jason E
authors.initials: JE
authors.lastname: Lang
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000379:methods*; D016063:Blood Loss, Surgical / Q000503:physiopathology*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006622:Hip Prosthesis; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D015207:Osteoarthritis, Hip / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D018579:Patient Selection; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D003668:Pressure Ulcer / Q000209:etiology / Q000503:physiopathology; D011474:Prosthesis Design; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome