Comparatively increased complications in obese patients undergoing total hip arthroplasty through a direct anterior approach

Abstract

Background: Direct Anterior IP replacement is a minimally invasive surgical technique. This approach involves a 3 to 4 inch incision on the front of the hip that allows the joint to be replaced by moving muscles aside along their natural tissue planes, without detaching any tendons. This approach often results in quicker recovery, less pain, and more normal function after hip replacement. The Direct Anterior (DA) approach for Total Hip Arthroplasty (THA) has demonstrated successful short term outcomes in several studies. However, there is no consensus about which patients are appropriate candidates for DA Total Hip Arthroplasty. It is also unclear if short term outcomes in obese patients undergoing THA through a DA approach are elevated in comparison to non-obese patients. Objective: The aim of this study was to evaluate complication rates and short term outcomes of obese, pre-obese, and normal Body Mass Index (BMI) patients undergoing Total Hip Arthroplasty with a Direct Anterior approach in a consecutive group of patients. Design: A retrospective study of 200 consecutive patients who underwent unilateral THA through a DA approach for osteoarthritis or avascular necrosis during the early peri-operative period. Duration: November 2016 to December 2017. Setting: Department of Orthopaedics, Bhaskar Medical College, Hyderabad. Participants: 200 consecutive patients who underwent unilateral THA through a DA approach. Methods: All adult patients undergoing primary total hip arthroplasty were eligible for inclusion. A retrospective chart review of 210 consecutive patients who underwent unilateral primary THA through a DA approach was conducted. All 200 cases used the same implants. The direct anterior approach utilized a modified Smith–Peterson interval. A standard operating table was used along with a femoral elevator. Routine use of fluoroscopy was not used. Unless contraindicated, patients were treated with a standardized pain protocol. A local tissue pain injection was administered as well as intravenous tranexamic acid. The same closure technique was utilized for all patients. Physical therapy followed a standardized protocol and began on postoperative day 0. Standard post-discharge follow-up was at two and six weeks. All patients were placed on aspirin 325 mg twice daily for DVT prophylaxis. Electronic and paper medical records were reviewed to determine surgical time, length of stay, discharge disposition, major and minor complications, and short-term outcome measures. Major and minor complications were separately described. Results: The obese group demonstrated increased surgical times, as well as increased length of stay, narcotic use, and assistive device use at two weeks. In addition, major complications and wound complications were both significantly increased in the obese group. There was also a trend toward increased use of rehabilitation facilities in the obese group at disposition. Conclusion: Obese patients undergoing a DA approach have many times increase in major and wound complications compared to patients with a BMI