Bilateral Total
Hip Replacements

0:00 · Introduction

Hello, welcome to our channel. My name is Dr Chien-Wen Liew. I'm a hip and knee replacement surgeon from Orthopaedics 360. And today I'm just talking a little bit about bilateral total hip replacements now.

0:21 · What is a bilateral total hip replacement

A bilateral total hip replacement means performing both of your hip replacements during the same anaesthetic. That means going into surgery and having both hips replaced at the same time.

0:31 · The direct anterior approach

As you may already know, I perform the direct anterior approach for all of my total hit replacements. This means that we do not cut any of the major nerves, blood vessels and muscles, and we certainly do not detach any tendons during the surgery. Due to this, we usually find that people recover from bilateral total hip replacements quite well, but they aren't for everyone. Our first consideration as to who is appropriate for a bilateral total hip replacement is a few different factors.

0:56 · Criteria for decising on bilateral hip replacements

The first one being are both of the hips actually as bad as each other? We would require our patients to have both of their hips being quite diseased, and you to feel like both hips are. Have equally got to the stage where they're affecting quality of life and causing you significant concerns. We do not generally offer a bilateral total hip replacement if one of your hips is severely arthritic and the other one is only a mild niggle.

Because that is something that can also be due to use shifting weight onto the less diseased one to offload the painful one. And it may well be that your less disease hip becomes more tolerable after we replace just one and may well last a few extra years now. If both of your hips are very diseased and you find it difficult to work out which one is actually the worst one, then certainly, a bilateral total hip replacement may be appropriate for you. Now, if you're very fit and healthy, this should not be a problem,

1:52 · When is it not appropriate?

but we do have a few concerns if you do have major cardiovascular or respiratory issues in your past medical history. So medical comorbidities do make up one of the major factors that we look for in determining whether or not you are suitable for a bilateral total hit replacement. In general, if you've had a previous heart attack or stroke, or if you have any major respiratory conditions like severe obstructive sleep apnea, or if you've had any major problems with surgery in the past, such as excessive bleeding and anaesthetic complication, or deep venus thrombosis or pulmonary embolisms.

Then we usually say that it's not that safe to perform two surgeries at the same time. Our efforts then would be more focused on reducing the impact as much as we can and performing one surgery at a time. And my criteria for how close we perform the two surgeries in that instance is 12 weeks apart minimum. Now, 3 months is usually the time when your body has fully returned back to its normal baseline.

Our literature supports somewhere between 8 to 12 weeks where your body has restored its normal red blood cells. So the any blood loss that occurred during the first surgery has been nullified. Your inflammatory markers are normal and all of your body's homeostasis has returned to normal. By the 3month mark, I would normally expect that people have recovered somewhere between 80 to 90% through the full recovery. After a total hip replacement, that doesn't change actually whether or not it's one or both hips.

That is quite a consistent marker being at the 3mon postoperative mark. Now, the final one is your body mass index, or BMI. The literature shows, and our joint registry shows a significant increase in complications from anaesthetic or surgery. When your BMI is above 30 to 35, so our general cut off or line in the sand is 35. If you have a BMI above 35, it is almost going to be a contraindication,

which means you cannot have a bilateral or bothside hip replacement during the same procedure. There are some exceptions to the rule. But in general, our literature is so strong on this that it would not make sense for us to have elevated risks for the marginal benefits. And that brings me on to the benefits of bilateral total hip replacements because the surgery is less invasive, our patients tend to recover really nicely after the surgery.

4:17 · Main goal of bilateral THR

However, the main goal for performing bilateral total hip replacements during the same anaesthetic is that you save a lot of rehabilitation time. Some patients find one combined recovery more convenient than two separate recoveries. So, if there is time pressure or a time concern, then bilateral simultaneous hip replacements is a good option when we perform the bilateral hip replacements, there is no difference on the day.

4:42 · What happens on the day

You still have the spinal anaesthetic, we still give you the light anaesthetic. So you are unaware of what we're doing, and we still try to get you up and walking the same day. Provided everything has gone smoothly with the first operation from a surgical and anaesthetic perspective, we then proceed with the second side. We always like to try to do your worst or most painful hip first.

So that in the very, very small chance that something happens with the surgery or anaesthetic, we've got the worst hip out the way. If that happens, I'll make the decision to not perform your second side for safety and then we come back 3 months later and perform it then.

5:24 · Moving after surgery

Now, mobilising after the surgery is no difference than having a single side, but please be aware that once you've had both sides done, it will feel a little bit awkward. And some people liken that to being a new baby giraffe. I said the same thing on my knee video. It's really something where if you get up and walk for the first time, both of the legs feel a little bit weak and foreign.

Of course, we like to wait until the spinal anaesthetic has fully worn off before you up and standing, otherwise there is that risk of you collapsing. When you first go to get up out of bed, the first thing to do is to sit on the edge of the bed, wriggle the toes. Allow your blood pressure to restore back to normal because the spinal anaesthetic will drop your blood pressure a little bit as well.

So we do like you to spend a few minutes on the edge of the bed, getting everything back to normal. Before you stand up for the first time, this will mean that the risk of you collapsing or anything occurring is very minimal. Our physios will guide you to walk and stand with the walking frame. Our goals on the day of surgery really are just to stand up, get the feel of putting both feet on the ground.

Taking a few steps, either on the spot or even a few steps forwards and backwards, is all that's required. We're not going for long walks on day zero, you will get up and walk a lot easier after that.

6:38 · Post op expectations

After a bilateral total hit replacement. We'd expect that. You need a walking frame for somewhere between 3 to 5 days, you can use it longer, I'd rather you use any walking aids for longer than you need it to avoid any falls. We then progress you to two walking sticks, and usually one side heals up faster than the other, at which point you can progress through to one walking stick.

To support the slower healing side. When you're comfortable to, you don't need to use any walking sticks. But I like you to carry a walking stick around just for those few days where you feel like you don't need it, just in case you need it. If you stumble and fall when your muscles haven't fully recovered after the surgery, I still expect you to feel quite good a couple of weeks after the surgery.

And most of my patients have come off all the heavy opioid analgesia by 2 to 3 weeks after the operation. Except for the nighttime one, most people find that the nighttime analgesia is the one that they require for the longest. And if that's the case, that's absolutely fine. Keep going with that, but during the day try to stay on Panadol if you can. Will. We will allow you to drive if you have been able to get off all the heavy pain medication during the day.

And if you're walking reasonably well with walking sticks. If you're still taking any of Palexia or Endone during the day, please do not drive because they will inhibit your reflexes and potentially cause some sort of incident after that. After the surgery, you will require a little bit more analgesia, such as Palexia or Endone. If you need more of those, I will actually send you an email with a little link in it for you to ask for more medication as you need.

Please check your email throughout this journey because we do send you a few things along the way so that you can check in. And make sure that you're along the same lines as what we would expect from you. And also so you have access to me directly.

8:22 · Long term expectations

Most people can expect good long-term function, but results vary between individuals. There is no difference to your long-term expectations compared to one side. The main reason, like I said, for you to consider having a bilateral hit replacement is to make sure that we're saving as much time as possible. And that is, your overall rehab time is cut in at least half. So, if time pressure, like I said before, is your main concern, a bilateral total HP replacement may be one for you to consider.

As always, any queries or questions, please reach out to me directly. Otherwise, I look forward to seeing you or discussing this with you in my rooms. Have a lovely day and I'll see you next time.

Transcript edited lightly for readability.