EXPERIENCE OF TOTAL HIP-REPLACEMENT AND ITS EFFECT ON RECOVERY AFTER 2ND HIP-REPLACEMENT

OBJECTIVE: To determine whether the knowledge gained through total hip replacement (THR) influences the time to recovery after a second THR. DESIGN: A retrospective study of data gathered prospectively on the recovery course of patients from their preoperative visit to 1 year after surgery. SETTING: A university teaching hospital PATIENTS: Sixty-nine patients underwent bilateral hip replacements at the Royal Victoria Hospital, Montreal, between May 1985 and May 1992. The inclusion criteria were: (a) similar diagnoses and prostheses bilaterally, (b) time between the two THRs of less than 3 years, (c) both replacements carried out by the same surgeon and (d) attendance at the arthroplasty clinic. Forty-one patients did not fulfil the criteria for inclusion, leaving 28 patients having 56 THRs for the study. An additional 28 patients who had unilateral hip arthroplasty were randomly chosen on the basis of sex and age to act as the control group. INTERVENTION: Bilateral cementless THR. MAIN OUTCOME MEASURES: Harris hip score at one preoperative visit and postoperatively at 6 weeks, 3 months, 6 months and 1 year. RESULTS: There were no significant differences in measures of recovery between the initial and the subsequent hip replacement at any of the time intervals. Significant differences were found only between the various time periods. CONCLUSIONS: Time and not familiarity dictated progress toward recovery for patients who underwent bilateral THR with cementless prostheses. Randomized clinical trials, assessing whether time to recovery, ultimate outcome and cost-effectiveness are affected by preoperative teaching programs, are necessary to further elucidate this important issue.