Total hip arthroplasty through the direct anterior approach in morbidly obese patients

Aims There is evidence that morbidly obese patients have more intra- and postoperative complications and poorer outcomes when undergoing total hip arthroplasty (THA) with the direct anterior approach (DAA). The aim of this study was to determine the efficacy of DAA for THA, and compare the complications and outcomes of morbidly obese patients with nonobese patients. Methods Morbidly obese patients (n = 86), with BMI ≥ 40 kg/m2 who underwent DAA THA at our institution between September 2010 and December 2017, were matched to 172 patients with BMI < 30 kg/m2. Data regarding demographics, set-up and operating time, blood loss, radiological assessment, Harris Hip Score (HHS), International Hip Outcome Tool (12-items), reoperation rate, and complications at two years postoperatively were retrospectively analyzed. Results No significant differences in blood loss, intra- and postoperative complications, or implant position were observed between the two groups. Superficial wound infection rate was higher in the obese group (8.1%) compared to the nonobese group (1.2%) (p = 0.007) and relative risk of reoperation was 2.59 (95% confidence interval 0.68 to 9.91). One periprosthetic joint infection was reported in the obese group. Set-up time in the operating table and mean operating time were higher in morbidly obese patients. Functional outcomes and patient-related outcome measurements were superior in the obese group (mean increase of HHS was 52.19 (SD 5.95) vs 45.1 (SD 4.42); p < 0.001), and mean increase of International Hip Outcome Tool (12-items) was 56.8 (SD 8.88) versus 55.2 (SD 5.85); p = 0.041). Conclusion Our results suggest that THA in morbidly obese patients can be safely and effectively performed via the DAA by experienced surgeons. Cite this article: Bone Jt Open 2022;3(1):4–11.

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Total hip arthroplasty performed by direct anterior approach – Does experience influence the learning curve?

SICOT-J ◽

10.1051/sicotj/2020015 ◽

2020 ◽

Vol 6 ◽

pp. 15 ◽

Cited By ~ 2

Author(s):

Constant Foissey ◽

Mathieu Fauvernier ◽

Cam Fary ◽

Elvire Servien ◽

Sébastien Lustig ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Learning Curve ◽

Hip Arthroplasty ◽

Anterior Approach ◽

Operating Time ◽

Surgical Techniques ◽

Direct Anterior Approach ◽

Clinical Results ◽

Total Hip ◽

Significant Difference

Introduction: Proficiency in the direct anterior approach (DAA) as with many surgical techniques is considered to be challenging. Added to this is the controversy of the benefits of DAA compared to other total hip arthroplasty (THA) approaches. Our study aims to assess the influence of experience on learning curve and clinical results when transitioning from THA via posterior approach in a lateral position to DAA in a supine position. Methods: A consecutive retrospective series of 525 total hip arthroplasty of one senior and six junior surgeons was retrospectively analysed from May 2013 to December 2017. Clinical results were analysed and compared between the two groups and represented as a learning curve. Mean follow up was 36.2 months ± 11.8. Results: This study found a significant difference in complications between the senior and junior surgeons for operating time, infection rate, and lateral femoral cutaneous nerve (LFCN) neuropraxia. A trainee’s learning curve was an average of 10 DAA procedures before matching the senior surgeon. Of note, the early complications correlated with intraoperative fractures increased with experience in both groups. Operating time for the senior equalised after 70 cases. Dislocation rate and limb length discrepancy were excellent and did not show a learning curve between the two groups. Conclusion: DAA is a safe approach to implant a THA. There is a learning curve and initial supervision is recommended for both seniors and trainees. Level of evidence: Retrospective, consecutive case series; level IV.

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Impact of body mass on hospital resource use in total hip arthroplasty

Public Health Nutrition ◽

10.1017/s1368980009005072 ◽

2009 ◽

Vol 12 (8) ◽

pp. 1122-1132 ◽

Cited By ~ 26

Author(s):

John A Batsis ◽

James M Naessens ◽

Mark T Keegan ◽

Amy E Wagie ◽

Paul M Huddleston ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Resource Utilization ◽

Hip Arthroplasty ◽

Tertiary Care ◽

Obese Group ◽

Morbidly Obese ◽

Obese Patients ◽

Total Hip ◽

Operative Costs ◽

The Impact

AbstractObjectiveTo determine the impact of BMI on post-operative outcomes and resource utilization following elective total hip arthroplasty (THA).DesignA retrospective cohort analysis on all primary elective THA patients between 1996 and 2004. Primary outcomes investigated using regression analyses included length of stay (LOS) and costs (US dollars).SettingMayo Clinic Rochester, a tertiary care centre.SubjectsPatients were stratified by pre-operative BMI as normal (18·5–24·9 kg/m2), overweight (25·0–29·9 kg/m2), obese (30·0–34·9 kg/m2) and morbidly obese (≥35·0 kg/m2). Of 5642 patients, 1362 (24·1 %) patients had a normal BMI, 2146 (38·0 %) were overweight, 1342 (23·8 %) were obese and 792 (14·0 %) were morbidly obese.ResultsAdjusted LOS was similar among normal (4·99 d), overweight (5·00 d), obese (5·02 d) and morbidly obese (5·17 d) patients (P= 0·20). Adjusted overall episode costs were no different (P= 0·23) between the groups of normal ($17 211), overweight ($17 462), obese ($17 195) and morbidly obese ($17 655) patients. Overall operative and anaesthesia costs were higher in the morbidly obese group ($5688) than in normal ($5553), overweight ($5549) and obese ($5593) patients (P= 0·03). Operating room costs were higher in morbidly obese patients ($3418) than in normal ($3276), overweight ($3291) and obese ($3340) patients (P< 0·001). Post-operative costs were no different (P= 0·30). Blood bank costs differed (P= 0·002) and were lower in the morbidly obese group ($180) compared with the other patient groups (P< 0·05). Other differences in costs were not significant. Morbidly obese patients were more likely to be transferred to a nursing home (24·1 %) than normal (18·4 %), overweight (17·9 %) or obese (16·0 %) patients (P= 0·001 each). There were no differences in the composite endpoint of 30 d mortality, re-admissions, re-operations or intensive care unit utilization.ConclusionsBMI in patients undergoing primary elective THA did not impact LOS or overall institutional acute care costs, despite higher operative costs in morbidly obese patients. Obesity does not increase resource utilization for elective THA.

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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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