Are There Benefits to One- versus Two-stage Procedures in Bilateral Hip Resurfacing?

Short-term studies report comparable complication rates of one-stage bilateral versus two-stage procedures in hip resurfacing, although the long-term effects of such procedures on survivorship, quality of life, and disease-specific scores are currently unknown. We compared clinical scores, length of stay, complication rates, and survivorship in patients who underwent bilateral hip resurfacing grouped on the basis of one-stage versus two-stage operation. We retrospectively reviewed 75 patients who underwent a one-stage procedure and 87 patients who had both hips resurfaced in separate procedures. The demographics and etiologies were similar for the two groups. The mean followup time was longer in the two-stage group (7.3 years; range, 2.6-12.3 years) than in the one-stage group (6.6 years; range, 2.6-10.9 years). We found no differences in the latest postoperative UCLA pain, walking function, and activity scores; Harris hip scores; or SF-12 scores between the two groups. The average length of stay was shorter for the one-stage group. The early complication rates were similar between the two groups. One-stage patients had a higher revision rate than the patients in the two-stage group (14 versus four hips, respectively), but this was not true for patients with femoral components 48 mm or greater in size. We found a greater rate of revisions in the one-stage group, suggesting possible long-term detrimental effects of the one-stage procedure. Our data suggest selecting patients with large component sizes if the surgeries are to be performed under one anesthesia. Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.