Comparison of Wound Complications Between Two Closing Techniques Following Total Hip Arthroplasty Via the Direct Anterior Approach

AbstractA higher rate of wound complications has been reported in the direct anterior approach (DAA) for total hip arthroplasty (THA), reportedly due to the location of the incision and poor surgical site exposure techniques. Therefore, the purpose of this study was to compare wound complications within the first 90 days between a zipper closing method (ZM) and subcuticular monocryl with dermabond skin closure (SMD). A total of 294 patients (352 hips) were closed using the SMD and 166 patients (206 hips) were closed via the ZM. All THAs via the DAA and postoperative care were performed based on the current standard of care for the treatment of symptomatic hip osteoarthritis, established by a single, high volume surgeon from 2016 to 2018. Any wound complications during the first 90 days were noted. Independent t-tests determined differences in descriptive variables. Additionally, a Fisher Exact test was performed to compare wound complication rate between groups (p < 0.05). Surgical time was significantly shorter for ZM (p < 0.001) for both unilateral and bilateral groups compared with SMD. Overall, there were four complications occurring in 558 cases (0.7%), with two cases (0.36%) requiring additional surgery. No wound complications were present in the SMD and four wound complications (1.9%), two requiring surgery, were reported for the ZM (χ2 [1, N = 558] = 6.884, p = 0.009). While no wound complications were reported in the SMD group, the ZM group sustained four wound complications, two of which required additional surgery. Two of these wound complications occurred within the first 14 cases following implementation of the ZM, perhaps indicating a short learning curve. The ZM is a quicker, perhaps easier closure method yet the added expense for materials and suggested increased risk for wound complications may moderate the enthusiasm of the ZM compared with the sutures following THA via the DAA.

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Are there more wound complications or infections with direct anterior approach total hip arthroplasty?

Hip International ◽

10.1177/1120700018759617 ◽

2018 ◽

Vol 28 (6) ◽

pp. 591-598 ◽

Cited By ~ 3

Author(s):

Christophe Tissot ◽

Matthias Vautrin ◽

Anais Luyet ◽

Olivier Borens

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Anterior Approach ◽

Direct Anterior Approach ◽

Wound Complication ◽

Wound Complications ◽

Obese Patients ◽

Total Hip ◽

Delayed Onset

Introduction: Compared to a lateral or posterior approach (PA), the direct anterior approach (DAA) does permit a better muscle preservation for total hip arthroplasty (THA). However, there is concern whether this advantage come with increased wound complication and infection leading to reoperation or sometimes major procedures. Method: We retrospectively reviewed all patients who underwent primary THA through the PA between January 2009 and April 2013 ( n = 796) and through the DAA between January 2011 and April 2013 ( n = 399) at our institution with a minimum of 2 years follow up regarding all wound complications and all infections. Results: Of the 796 patients in the PA group, there were 6 wound complications leading to reoperation and 6 infections; 4 early and 2 delayed onset. Among the infected cases, one was obese (body mass index [BMI] >30 kg/m2). Two procedures were teaching-based. Of the 399 patients in the DAA group, there were three dehiscences leading to reoperation, two of which were in obese patients. 6 infections were also found; 4 with early and 2 with delayed onset. Of the infected cases, three were obese. 4 procedures were teaching-based. Conclusion: In our series of patients undergoing THA, the DAA did not increase the rates of either wound complications leading to reoperation nor early or delayed infection compared to the PA.

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Dislocation rates following total hip arthroplasty via the direct anterior approach in a consecutive, non-selective cohort

The Bone & Joint Journal ◽

10.1302/0301-620x.103b7.bjj-2020-2297.r1 ◽

2021 ◽

Vol 103-B (7 Supple B) ◽

pp. 38-45

Author(s):

John V. Horberg ◽

Benjamin R. Coobs ◽

Aneel K. Jiwanlal ◽

Christopher J. Betzle ◽

Susan G. Capps ◽

...

Keyword(s):

Risk Factors ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Anterior Approach ◽

Direct Anterior Approach ◽

Dislocation Rate ◽

Fixation Method ◽

Wound Complications ◽

Total Hip

Aims Use of the direct anterior approach (DAA) for total hip arthroplasty (THA) has increased in recent years due to proposed benefits, including a lower risk of dislocation and improved early functional recovery. This study investigates the dislocation rate in a non-selective, consecutive cohort undergoing THA via the DAA without any exclusion or bias in patient selection based on habitus, deformity, age, sex, or fixation method. Methods We retrospectively reviewed all patients undergoing THA via the DAA between 2011 and 2017 at our institution. Primary outcome was dislocation at minimum two-year follow-up. Patients were stratified by demographic details and risk factors for dislocation, and an in-depth analysis of dislocations was performed. Results A total of 2,831 hips in 2,205 patients were included. Mean age was 64.9 years (24 to 96), mean BMI was 29.2 kg/m2 (15.1 to 53.8), and 1,595 patients (56.3%) were female. There were 11 dislocations within one year (0.38%) and 13 total dislocations at terminal follow-up (0.46%). Five dislocations required revision. The dislocation rate for surgeons who had completed their learning curve was 0.15% compared to 1.14% in those who had not. The cumulative periprosthetic infection and fracture rates were 0.53% and 0.67%, respectively. Conclusion In a non-selective, consecutive cohort of patients undergoing THA via the DAA, the risk of dislocation is low, even among patients with risk factors for instability. Our data further suggest that the DAA can be safely used in all hip arthroplasty patients without an increased risk of wound complications, fracture, infection, or revision. The inclusion of seven surgeons increases the generalizability of these results. Cite this article: Bone Joint J 2021;103-B(7 Supple B):38–45.

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Greater Prevalence of Wound Complications Requiring Reoperation With Direct Anterior Approach Total Hip Arthroplasty

The Journal of Arthroplasty ◽

10.1016/j.arth.2014.04.036 ◽

2014 ◽

Vol 29 (9) ◽

pp. 1839-1841 ◽

Cited By ~ 94

Author(s):

Christian P. Christensen ◽

Tharun Karthikeyan ◽

Cale A. Jacobs

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Anterior Approach ◽

Direct Anterior Approach ◽

Wound Complications ◽

Total Hip

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Preoperative radiographs to predict component malposition in direct anterior approach total hip arthroplasty

Hip International ◽

10.1177/11207000211037596 ◽

2021 ◽

pp. 112070002110375

Author(s):

Matthew D Free ◽

Ian Barnes ◽

Matthew Hutchinson ◽

Paul Harvie

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Anterior Approach ◽

Femoral Stem ◽

Direct Anterior Approach ◽

Target Range ◽

Neck Shaft Angle ◽

Total Hip ◽

Increased Risk ◽

Component Malposition

Introduction: There is conflicting evidence as to whether or not patients undergoing total hip arthroplasty (THA) via the direct anterior approach (DAA) have increased risk of component malposition. The aim of this study was to investigate whether specific preoperative radiographic features were predictive of postoperative component malposition in DAA THA. Patients and methods: We examined 204 THA operations performed for osteoarthritis via the DAA at a single institution. Preoperative radiographs were analysed with numerous pre-specified measurements and classifications being recorded. Postoperative radiographs were analysed to determine if any of these preoperative radiographic factors correlated with component malposition in regard to cup inclination, cup version, femoral stem coronal alignment, leg-length discrepancy (LLD) and femoral offset discrepancy. Results: Numerous preoperative factors were associated with component malposition. Coxa profunda was found to be a significant predictor of cup anteversion being outside of the target range ( p = 0.0089) and an increased centre-edge angle was a significant predictor for a postoperative LLD ( p = 0.0134). A decreased neck-shaft angle ( p = 0.0007) and a lower preoperative LLD ( p = 0.0019) were both predictive of femoral stem coronal malalignment. Conclusions: Preoperative radiographs can be a valuable tool for surgeons in predicting patients at risk of component malposition in DAA THA.

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Early failure of an uncemented femoral stem, as compared to two other stems with similar design, following primary total hip arthroplasty performed with direct anterior approach

Hip International ◽

10.1177/1120700020940671 ◽

2020 ◽

pp. 112070002094067

Author(s):

George A Macheras ◽

Panagiotis Lepetsos ◽

Spyridon P Galanakos ◽

Stamatios A Papadakis ◽

Lazaros A Poultsides ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Aseptic Loosening ◽

Hip Arthroplasty ◽

Anterior Approach ◽

Population Sample ◽

Femoral Stem ◽

Direct Anterior Approach ◽

Total Hip ◽

Increased Risk

Introduction: An increased risk of early femoral component loosening has been reported using the direct anterior approach (DAA) compared with other common surgical approaches. However, long-term data are scarce. The purpose of this study is: (1) to determine the incidence of early femoral loosening in a high volume, single surgeon’s practice utilising the DAA approach; and (2) to examine the effect of stem design and type of coating on aseptic loosening in the early and mid-term postoperative period. Methods: A retrospective review of 1650 consecutive patients (1800 hips) who underwent total hip arthroplasty (THA) using the DAA between August 2011 and December 2017 was conducted at our institution. 3 types of uncemented femoral stems (Quadra-S, Avenir, TwinSys), with similar design, but different coating, were implanted. Patients were evaluated clinically and radiologically at 4 weeks, 3 months, 1 year, and annually thereafter. Results: After a mean follow-up of 46.4 months, the total incidence of revision for aseptic loosening was 0.44% ( n = 8). All loose stems were Quadra-S, failing to achieve osseointegration, for an overall incidence of 0.96% ( p = 0.002). None of the other stems were loose. Radiolucent lines around the proximal stem portion were visible in 75 Quadra-S stems (4.1%) on radiographs taken at 1 year postoperatively and continued to deteriorate at the latest follow-up. Conclusions: In this specific cohort of patients, the increased rate of femoral stem aseptic loosening was implant-related and was attributed only to a specific type of femoral stem (Quadra-S). No relation to other factors was proven suggesting that the surface characteristics of this femoral stem and the lack of bioactive coating are responsible for the observed early femoral failures. These findings should be confirmed by additional registry work and larger population sample sizes are needed to evaluate the prosthesis performance after implantation through the DAA.

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