Dear Panayot

I think the bilateral THR in one stage is an exception . Normally the THR is an elective surgical procedure and if the patient has bilateral coxarthrosis, or other conditions, are in different stages as well as in different clinical presentations. The average time of THR, in my hands, is approximately 2 hours in which bleeding occurs despite being controlled. My option is posterior approach in THR with the patient in lateral decubitus position and this would bring more complications in case of THR bilateral in one stage. The post operative period would be more difficult and the disadvantages greatly outweigh the advantages . I prefer to wait three months to operate the other hip

Thank you, Nelson. In the past I did several patients bilaterally in one stage. This was successful but the operation was very demanding and the postoperative period was difficult. I also do not recommend such approach any more. I agree that it could be done as an exception. Probably in severely affected rheumatoid-arthritis patients or Bechterew patients with bilaterally ankylosed hips.

Dear Dr Panayot,

Where I trained and worked as a junior faculty in Mumbai, We were rather experienced with single stage bilateral THA. The indications were predominantly ankylosing spondylitics. These patients would not be ambulant unless operated in one sitting. The essential points in favour of doing a single stage are 1. An adequate theatre setting which must be able to maintain the environment throughout the two cases. This for me is very important and in my practice, is deficient in my theatre environment, hence I do not practice bilateral THA at present i one sitting. 2. An anaesthesia clearance. 3. Two different ( not reautoclaved) set of instruments.

In a typical case we would complete one side and then asess whether the patient should be considered fit for undergoing the other side by looking at blood loss, general condition urine output, complications during the first surgery etc.

The complication rate was not higher, the reoperation rate was not higher nor was there any significant infection rate in those cases.

regards

Murali Poduval

Thank you, Dr. Poduval,

I agree with you. The indications for one-stage bilateral THR are highly selective and need special settings,anesthesia, theatre environment, prepared team, adequate postsurgery care, etc. Anyway, it should not be the routine practice.

Thank you Dr. Malyk,

I believe you are right. One-stage THR should be preserved for special cases with strict indications.

Regards

Dear Dr. Panayot

I agree that bilateral THA should be reserved for patients who support this procedure. Previous careful clinical evaluation , where necessary .

I have observed increased demand of patients for such treatment .

I reserve this for specific cases

Thank you Dr. Rodrigo, for your relevant answer.

Regards