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 r ecovery course of patients from their preoperative visit to 1 year aft er surgery. SETTING: A university teaching hospital PATIENTS: Sixty-ni ne patients underwent bilateral hip replacements at the Royal Victoria Hospital, Montreal, between May 1985 and May 1992. The inclusion crit eria were: (a) similar diagnoses and prostheses bilaterally, (b) time between the two THRs of less than 3 years, (c) both replacements carri ed out by the same surgeon and (d) attendance at the arthroplasty clin ic. Forty-one patients did not fulfil the criteria for inclusion, leav ing 28 patients having 56 THRs for the study. An additional 28 patient s who had unilateral hip arthroplasty were randomly chosen on the basi s of sex and age to act as the control group. INTERVENTION: Bilateral cementless THR. MAIN OUTCOME MEASURES: Harris hip score at one preoper ative visit and postoperatively at 6 weeks, 3 months, 6 months and 1 y ear. RESULTS: There were no significant differences in measures of rec overy between the initial and the subsequent hip replacement at any of the time intervals. Significant differences were found only between t he various time periods. CONCLUSIONS: Time and not familiarity dictate d progress toward recovery for patients who underwent bilateral THR wi th cementless prostheses. Randomized clinical trials, assessing whethe r time to recovery, ultimate outcome and cost-effectiveness are affect ed by preoperative teaching programs, are necessary to further elucida te this important issue.