The direct anterior or direct lateral approach for simultaneous bilateral total hip arthroplasty: A functional recovery and in-hospital cost analysis
Bibliographic record
Abstract
Background: Simultaneous bilateral total hip arthroplasty (sbTHA) has been demonstrated to be an excellent option for medically fit patients. To our knowledge, no previous studies have compared differences in patient-reported outcome measures (PROM) and costs of sbTHA performed via the direct anterior (DA) or direct lateral (DL) approaches. Methods: We performed a retrospective cohort analysis of patients at our institution who underwent sbTHA between 2006 and 2020 with a minimum 1-year follow-up. Functional outcomes were assessed using the Harris Hip Score, the Western Ontario MacMaster Arthritis Index, and Veteran RAND 12 Item Health Survey scores preoperatively and at 1 year postoperatively. Limb length and combined offset discrepancy were assessed on the first standing postoperative radiograph. Perioperative costs were compiled from charts and adjusted for inflation before cost analysis. Results: A 2:1 match for age and sex selected 34 DA and 17 DL subjects. Diagnoses were similar among groups. The DA group had a significantly lower body mass index (26.99 vs. 32.61, p = 0.0009). There was no difference in the change in PROM or radiographic measures at 1-year postoperatively between groups. The DA group demonstrated significantly lower reported limp (8.3% vs. 46.2%, p = 0.013), procedure time (125.74 vs. 156.41 min, p < 0.001), operating room time (165.68 vs. 194.59 min, p = 0.005), length of stay (1.97 vs. 6.65 days, p < 0.001), and rehab discharge (11.8% vs. 47.1%, p = 0.012). Total perioperative costs were significantly less for the DA group (CAD 13,699.37 vs. CAD 18,491.82), with a mean difference of CAD 4792.45 ( p < 0.001). Conclusion: The DA approach showed reduced length of stay and surgical time, resulting in lower perioperative costs. PROM showed no difference; however, DA patients were less likely to have a limp 1-year postoperatively. Thus, the DA approach may lead to a better gait and lower costs for those undergoing sbTHA.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".