Abstract
Background
The purpose of this study was to compare the posterior approach (PA) with the direct
anterior approach (DAA) among obese and nonobese total hip arthroplasty patients to
determine if obese DAA patients have a higher risk of infection or wound complications
compared with obese PA patients.
Methods
We retrospectively evaluated 4651 primary total hip cases performed via anterior approach
or PA between 2009 and 2015. Patients were divided into 4 study groups based on approach
and body mass index (BMI): (1) DAA <35 kg/m2, (2) DAA ≥35 kg/m2, (3) PA <35 kg/m2, and (4) PA ≥35 kg/m2. Infection rates and wound complications were compared.
Results
The rate of deep infection in groups 1 and 3 (nonobese anterior vs posterior) was
0.28% and 0.36%, respectively (P = .783); and in groups 2 and 4 (obese anterior vs posterior) was 2.35% and 2.7%,
respectively (P = .80). The rate of wound complications between groups 1 and 3 (nonobese) was 1.0%
and 0.3%, respectively (P = .005). Between groups 2 and 4 (obese), the rates of complications were 1.7% and
1.4%, respectively (P = 1.0). There was no difference in reoperation rates for wounds between groups 1
and 3 or between groups 2 and 4 (P = .217, P = .449).
Conclusion
In the largest available series, there was no difference in deep infection rates between
the 2 approaches. In the subset of obese patients with BMI ≥35 kg/m2, there was no increased risk of deep infection or wound complications in DAA patients
compared with PA patients. However, anterior hip cases experienced higher rates of
superficial wound complications compared with posterior cases across all BMIs.
Keywords
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Article info
Publication history
Published online: August 03, 2017
Accepted:
July 27,
2017
Received in revised form:
June 22,
2017
Received:
October 28,
2016
Footnotes
One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to http://dx.doi.org/10.1016/j.arth.2017.07.047.
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
