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      Surgical accuracy, function, and quality of life of simultaneous versus staged bilateral Total hip Arthroplasty in patients with Osteonecrosis of the femoral head

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          The optimal surgical option for patients requiring bilateral hip replacement remains controversial. The purpose of this study was to compare surgical accuracy; functional outcome and health-related quality of life; and prosthetic-related complications and revision surgery of a simultaneous bilateral total hip arthroplasty (THA) with those of a staged bilateral THA with an interval between procedures <12 months.


          A total of 123 unselected consecutive patients (mean age, 43.3 years) who underwent bilateral THAs for osteonecrosis of the femoral head (ONFH) with a minimum follow-up of two years (mean, 60.2 months) were studied retrospectively; 63 simultaneous procedures served as a test group and 60 staged procedures served as a control group.


          The mean postoperative leg-length discrepancy (LLD) and the percentage of patients who had an LLD >3 mm were significantly lower in the simultaneous group ( P < 0.001 and P = 0.001, respectively). A higher number of cups within the safe zones, a higher correction rate, and a lower failure rate for the cup placement in the second-operated hip were also identified in the simultaneous group. The mean Harris hip score, EuroQol-5D index, and EuroQol-visual analogue scale score were all better in the simultaneous group at the latest follow-up ( P < 0.001, in all comparisons). We found that the simultaneous procedure was associated with a lower incidence of postoperative prosthetic-related complications and revision surgery.


          We suggest that bilateral ONFH could be treated with a simultaneous THA rather than a staged THA to achieve a better surgical outcome.

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          Most cited references 31

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          Dislocations after total hip-replacement arthroplasties.

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            Nontraumatic Osteonecrosis of the Femoral Head: Where Do We Stand Today? A Ten-Year Update.

            ➤ Although multiple theories have been proposed, no one pathophysiologic mechanism has been identified as the etiology for the development of osteonecrosis of the femoral head. However, the basic mechanism involves impaired circulation to a specific area that ultimately becomes necrotic.➤ A variety of nonoperative treatment regimens have been evaluated for the treatment of precollapse disease, with varying success. Prospective, multicenter, randomized trials are needed to evaluate the efficacy of these regimens in altering the natural history of the disease.➤ Joint-preserving procedures are indicated in the treatment of precollapse disease, with several studies showing successful outcomes at mid-term and long-term follow-up.➤ Studies of total joint arthroplasty, once femoral head collapse is present, have described excellent outcomes at greater than ten years of follow-up, which is a major advance and has led to a paradigm shift in treating these patients.➤ The results of hemiresurfacing and total resurfacing arthroplasty have been suboptimal, and these procedures have restricted indications in patients with osteonecrosis of the femoral head.
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              The John Charnley Award: risk factors for cup malpositioning: quality improvement through a joint registry at a tertiary hospital.

              Few studies have examined factors that affect acetabular cup positioning. Since cup positioning has been linked to dislocation and increased bearing surface wear, these factors affecting cup position are important considerations. We determined the percent of optimally positioned acetabular cups and whether patient and surgical factors affected acetabular component position. We obtained postoperative AP pelvis and cross-table lateral radiographs on 2061 consecutive patients who received a THA or hip resurfacing from 2004 to 2008. One thousand nine hundred and fifty-two hips had AP pelvic radiographs with correct position of the hip center, and 1823 had both version and abduction angles measured. The AP radiograph was measured using Hip Analysis Suite™ to calculate the cup inclination and version angles, using the lateral film to determine version direction. Acceptable ranges were defined for abduction (30°-45°) and version (5°-25°). From the 1823 hips, 1144 (63%) acetabular cups were within the abduction range, 1441 (79%) were within the version range, and 917 (50%) were within the range for both. Surgical approach, surgeon volume, and obesity (body mass index > 30) independently predicted malpositioned cups. Comparison of low versus high volume surgeons, minimally invasive surgical versus posterolateral approach, and obesity versus all other body mass index groups showed a twofold (1.5-2.8), sixfold (3.5-10.7), and 1.3-fold (1.1-1.7) increased risk for malpositioned cups, respectively. Factors correlated to malpositioned cups included surgical approach, surgeon volume, and body mass index with increased risk of malpositioning for minimally invasive surgical approach, low volume surgeons, and obese patients. Further analyses on patient and surgical factors' influence on cup position at a lower volume medical center would provide a valuable comparison. Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

                Author and article information

                82-2-2258-2838 ,
                BMC Musculoskelet Disord
                BMC Musculoskelet Disord
                BMC Musculoskeletal Disorders
                BioMed Central (London )
                17 June 2017
                17 June 2017
                : 18
                ISNI 0000 0004 0470 4224, GRID grid.411947.e, Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, , The Catholic University of Korea, ; Banpodae-ro 222, Seocho-gu, Seoul, 137-701 South Korea
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

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