Bilateral Total Hip Replacement

What is Bilateral Total Hip Replacement?

Bilateral total hip replacement (BTHR), also known as bilateral hip arthroplasty, is a surgical procedure in which both hip joints are replaced with prosthetic implants. This operation is typically performed to relieve pain and improve function in patients with severe hip arthritis or other debilitating hip conditions affecting both hips.

Your surgeon may employ any of the following bilateral total hip replacement approaches:

• Simultaneous BTHR: Both hips are replaced in a single surgical session. This approach has the advantage of a single hospitalization and rehabilitation period.
• Staged BTHR: Each hip is replaced in separate surgeries, typically spaced a few months apart, allowing one hip to recover before the second surgery.

Anatomy of the Hip

The hip joint is one of the body's largest weight-bearing joints and is the point where the thighbone (femur) and pelvis (acetabulum) join. It is a ball-and-socket joint in which the head of the femur forms the ball, and the pelvic acetabulum forms the socket. The joint surface is covered by smooth articular cartilage that cushions and enables frictionless movement of the joint. The bones are held together by bands of tissue called ligaments that provide stability to the joint.

Indications for Bilateral Total Hip Replacement

Bilateral total hip replacement may be recommended for the following conditions:

• Severe Osteoarthritis: The most common reason for hip replacement.
• Rheumatoid Arthritis: An autoimmune condition causing joint inflammation and damage.
• Avascular Necrosis: Death of bone tissue due to lack of blood supply.
• Hip Dysplasia: Abnormal development of the hip joint.
• Trauma: Severe fractures or injuries affecting both hips.

Preparation for Bilateral Total Hip Replacement

In general, preparation for bilateral total hip replacement may include:

• A comprehensive medical evaluation, including a review of your medical history and physical examination, blood tests, and other relevant tests to assess your overall health and suitability for the surgery.
• Imaging studies such as X-rays or MRI scans of the hips to evaluate the extent of damage and plan the surgery.
• Informing your doctor of any allergies to medications, anesthesia, or latex.
• Providing your physician with a list of medications or supplements you are taking.
• You may need to adjust or temporarily stop taking certain medications - especially those that can affect blood clotting.
• Stopping smoking, as it can impact the healing process and increase the risk of complications.
• Abstaining from food or drink for at least 8 hours prior to the surgery.

Procedure for Bilateral Total Hip Replacement

In general, the procedure for bilateral total hip replacement may include the following steps:

• The patient is administered general anesthesia or a spinal block to ensure they are pain-free during the surgery.
• The patient is positioned on the operating table, typically lying on their side or back, depending on the surgical approach.
• The surgeon makes incisions over each hip joint. This can be done sequentially or simultaneously, depending on the surgical plan and the patient’s condition.
• Muscles and tissues are moved aside to expose the hip joint.
• The surgeon removes the damaged femoral head and acetabulum (hip socket).
• Implantation of Prosthetic Components:
  • Femoral Component: A metal stem is inserted into the femur. The femoral head is replaced with a metal or ceramic ball.
  • Acetabular Component: The hip socket is fitted with a metal shell lined with plastic, metal, or ceramic.
• The surgeon ensures proper alignment and fit of the prosthetic components.
• The incisions are closed with sutures or staples, and sterile dressings are applied.

Postoperative Care and Recovery

In general, postoperative care and recovery from bilateral total hip replacement may involve the following:

• You are monitored in the recovery room until the effects of anesthesia wear off. You will typically require 3 to 5 days of hospitalization.
• Medications are administered to manage pain and prevent infections.
• Incision care instructions are provided to keep the incision site clean and dry.
• You are advised to avoid strenuous activities, such as exercise and heavy lifting during the healing period.
• Physical therapy starts soon after surgery to encourage movement and prevent complications like blood clots.
• A structured rehabilitation program is followed to restore strength and mobility. This includes exercises and guidance on safe movement practices.
• You may take several months to fully recover, with most patients resuming normal activities within 3-6 months.
• Regular follow-up visits to monitor recovery and the condition of the hip implants and address any concerns.

Risks and Complications

Risks and complications associated with bilateral total hip replacement include:

• Infection
• Bleeding
• Blood clots
• Implant loosening or failure
• Nerve or blood vessel damage
• Anesthesia risks