SICOT J. 2025;11:31. doi: 10.1051/sicotj/2025023. Epub 2025 May 22.

ABSTRACT

INTRODUCTION: This study analyzed complication rates in two-stage bilateral Total Hip Arthroplasty (THA) across three distinct inter-stage intervals to determine the optimal timing for minimizing risk.

METHODS: This was a retrospective, multicentre, analytic study. The three intervals evaluated were <2 weeks (Group A), 2-12 weeks (Group B), and >12 weeks (Group C). The primary outcomes were blood transfusions, thromboembolic events (TVE), and coronary events, and the secondary outcomes were hospital stay, respiratory complications, reintervention, and mortality. The associations between demographic characteristics and complications and the risk hazard of complications were determined.

RESULTS: A total of 331 patients were included: 86 in Group A, 47 in Group B, and 198 in Group C. Blood transfusions after the second THA were performed in 29.1%, 14.9%, and 7.6% of the time interval groups respectively (p = 0.000). One TVE (1.1%) was recorded in group A and 4 (2%) in group C (p = 0.613).

CONCLUSIONS: Two-stage bilateral THA with a time interval between both surgeries of <2 weeks presented a significantly higher rate of blood transfusions than longer time intervals between surgeries, with an HR of 2.4 (CI: 95% 1.7-3.3, p = 0.000). The incidences of thromboembolic and coronary events were similar between the different timeintervals, demonstrating that two-stage bilateral THA is safe when performed with an interval of at least 2 weeks between both surgeries.

PMID:40403169 | PMC:PMC12097731 | DOI:10.1051/sicotj/2025023

SICOT J. 2025;11:30. doi: 10.1051/sicotj/2025025. Epub 2025 May 19.

ABSTRACT

BACKGROUND: Total knee arthroplasty (TKA) in patients with prior anterior cruciate ligament reconstruction (ACLR) presents unique challenges due to altered knee kinematics, residual instability, and fixation implants that may interfere with implant positioning. Image-based robotic-assisted TKA enables the functional alignment (FA) strategy that accounts for individual bony anatomy, ligamentous laxities, and anterior compartment characteristics.

SURGICAL TECHNIQUE: This technique involves a CT-based robotic workflow where femoral and tibial components are planned based on patient-specific alignment and soft tissue balance. Intraoperative assessment with a digital tensioning device guides fine-tuning of flexion and extension gaps, ensuring balanced implant positioning while minimizing soft tissue releases. Fixation implants from prior ACLR are identified using robotic navigation, allowing for targeted adjustments such as selective removal or controlled elevation of components to avoid excessive bone loss. Patellar tracking is dynamically evaluated with a probe, facilitating real-time adjustments to optimize mediolateral tracking and anterior offset.

DISCUSSION: Given the altered biomechanics in post-ACLR knees, FA may provide a physiological alignment by accommodating native laxities and reducing the risk of residual instability. Additionally, robotic guidance allows for precise management of fixation implants, ensuring optimal implant positioning and bone preservation. While further studies are needed, robotic-assisted FA represents a promising approach for enhancing outcomes in TKA for post-ACLR patients.

PMID:40391825 | PMC:PMC12091943 | DOI:10.1051/sicotj/2025025