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| Bilateral Surgery:
Occasionally
we get requests for Bilateral
Hip replacement or resurfacing
surgery. This is particularly relevant
when the patient is traveling a long
distance for surgery or particularly
requests bilateral surgery. With Bilateral
surgery the surgery is carried out on
one side first followed by the other
side one week later. This gives time
for the first side to receive some physiotherapy
prior to the second replacement. The
duration of stay in hospital is significantly
increased with bilateral hip replacement
or resurfacing.
Patients
with both hips equally painful
and stiff often wonder whether
both hips will need total
hip replacement operation,
and whether it will be possible
to walk on two artificial
hip joints. |
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Patients
with both hips equally painful and
stiff often wonder whether both hips
will need total hip replacement operation,
and whether it will be possible to
walk on two artificial hip joints.
The surgery that replaces both worn
hips is called bilateral total hip
operation. You should know that bilateral
hip surgery is done routinely and
it presents one of the most spectacular
successes of the total hip replacement
surgery. This is so because two impaired
hips cause much more symptoms than
twice the symptoms caused by one diseased
hip. Patients with both hips affected
have no healthy leg to rely on!
-
Staged Total Hip Replacement.
The
surgeon may replace your destructed
hip joints one at a time, at
two separate operations, often
several months apart one from
the other. You will need two
hospital stays, two anesthesia
and two rehabilitation periods.
The surgeons call these two
surgeries for Staged Total Hip
Replacement.
-
Simultaneous
Bilateral Total Hip Replacement.
But
if you have both hips equally painful
and stiff, it is possible to have
both hips replaced with total hip
prostheses during one operation
seance, under one anesthesia. The
operations are followed by a single
rehabilitation period within one
hospital stay. Such two simultaneous
surgeries are called Simultaneous
Bilateral Total Hip Replacement.
Who
should have a Bilateral Total Hip
replacement?
Patients of
almost all ages who have severe pain
and stiffness in both hips; patients
whose hip impairment makes their lives
miserable, restricts considerably
their activities of daily living ,
and progresses over time. Especially
patients with fixed deformity of both
hips and concomitant impairment of
the back (lumbar spine) are candidates
for bilateral total hip replacement.
Fixed deformity of both hip joint
imposes strain on low back and these
patients often have more symptoms
from their back spines than from their
hip joints. Also
patients with bilateral painful osteoarthritis
of the hip joints and contemplated
total knee replacement should have
both hips operated first.
Should
the X-ray changes of the other hip
alone decide the bilateral operation?
If
you have one bad hip and one good
hip and both hips show X-ray signs
of osteoarthritis, should you have
both hips replaced at once?
-
No.
You should have total hip replacement
only of that hip which gives you
pain and stiffness.
-
You should not have bilateral total
hip replacement only because X-rays
of both of your hips show osteoarthritic
changes.
-
There is, however, a 54 % chance
that you will need a total hip replacement
of the second symptomless hip (with
apparent X-ray changes) during the
next ten years.
(If your second hip shows no X-ray
changes, there is still an 8 % chance
that you will need total hip replacement
of this healthy hip during the next
ten years. -Ritter et al. 1996.)
Will
the impairment of the other hip recede
after operation on one side?
It is possible,
but it is not predictable. It is no
idea to wait too long with the operation
of the other painful hip in these
cases:
-
All
patients with severe flexion deformity
in both of their hips (hips that
are stiff in forward bent position)
-
All patients with failed total hip
arthroplasty on one side and impairment
of the other hip joint. These patients
need a "good hip to stand on"
while being treated for the failed
total hip.
-
Aged patients. In these patients
a medical complication may develop
and prevent the second operation.
An elderly patient, who was suffering
misery from bilateral hip impairment
is able to function "normally"
in 2 to 3 weeks after bilateral
replacement. The psychical state
(depression) of these patients often
improves after their source of pain
has been removed.
My
total hip replacement on one side
has been infected, can I have total
hip replacement of the opposite painful
hip ?
Yes, of course.
The combination of one already failed
total hip arthroplasty with severely
impaired other hip (opposite) is extremely
incapacitating. Total hip replacement
of the impaired contralateral (opposite)
hip is the only possible solution
of the patient misery. The risk of
blood-borne infection from the infected
contralateral hip is, of course, present,
but with careful antibiotic treatment
and prevention, this risk is low.
(Eftekhar, 1994)
Who
is the candidate for a Staged Total
Hip replacement?
Because the
staged operations put less stress
on you heart and circulation system,
this is a choice for patients with
cardiac, circulatory and pulmonary
diseases, or for older patients (arbitrarily
> 75). The disadvantages are, of
course, two separate surgeries, two
anesthesias and much longer total
hospital stay.
Who
is the candidate for Simultaneous
Total Hip Replacement?
Because this
simultaneous surgery include increased
stress on the patient's cardiovascular
system, the candidates must be carefully
selected. Only patients in good health
condition, without any cardiac, circulatory
and pulmonary diseases, and younger
than 75 years old are appropriate
candidates. The decision to undergo
Simultaneous Total Hip Replacement
must be taken after careful consultation
between the medical consultant (cardiologist),
the anesthesiologist, the surgeon,
and the patient. If you consider this
surgery, you will also need a good
general muscle condition, because
the initial rehabilitation will demand
more work from your arms than usually.
During the first weeks after the Simultaneous
THR, you will namely have "no
good leg to stand on".
Not
more complications
Several statistics
shoved that Simultaneous Total Hip
Replacement and Staged Total Hip Replacement
are equally safe operations. (Ritter
1996)The total blood loss and the
total operation time are the same
for one- and two-stage operations
and also the complications from anesthesia
are not more frequent after one-stage
operations. The total costs are 25
% lower for one-stage operations.
Weight
bearing
The weight
bearing may be a problem for patients
with cementless bilateral total hip
replacements. But several surgeons
allow their patients "full weight"
bearing immediately after the operation,
if the cementless total hip prostheses
were anchored stable during the operation.
The immediate weight bearing in these
patients did not cause any complications,
on the contrary the speed of recovery
was quickened.
What
are the results of these operations?
Several statistics
show that both types of procedures
produce equivalent and equally good
results.
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