Simultaneous Bilateral Direct Anterior Total Hip Arthroplasty Utilizing a Modular Neck-Sparing Arthroplasty Femoral Stem - Case Report and Literature Review

Abstract

Total hip arthroplasty for the management of bilateral hip osteoarthritis has been described in the literature since the 1970’s, utilizing either a simultaneous (single anesthetic) or staged (multiple anesthetics) technique. Utilization of a direct anterior approach to the hip joint allows for simultaneous bilateral total hip arthroplasty, without the need for re-positioning or re-draping the patient during the operation. The procedure is performed in a sequential fashion focused on a single side, with completion of the procedure before immediately proceeding to the contralateral side. The use of femoral-neck sparing arthroplasty design spans greater than 30 years,1 with a focus on preservation of proximal bone stock for younger, active patients who are undergoing arthroplasty at a young age and may need future revision surgery. Success rates reported by Dr. Pipino in his series included 97% satisfactory radiographic results, and an implant survival rate of almost 100% at 25 years. The modern, press-fit, modular neck-sparing arthroplasty design has been available in the United States and Australia for nearly 3 years, and enables the surgeon to perform intraoperative customization of the hip biomechanics for each case. Additionally, the standard 12/14mm trunnion allows the surgeon to choose the femoral head and bearing material, allowing options for metal on polyethylene, ceramic on ceramic, ceramic on poly, or ceramic on metal couples, in order to help avoid the use of metal on metal couples that have demonstrated higher complication rates in the recent literature. To the best of our knowledge, we present the world’s first case report of a simultaneous, bilateral, direct anterior total hip arthroplasty utilizing a modular neck-sparing arthroplasty femoral stem design.