Comparison of 90-Day Complications Between Direct Anterior and Postero-Lateral Total Hip Arthroplasty in Morbidly Obese Patients.
TL;DR
It is suggested that both DA and PL can be safely utilized in MO patients undergoing THA, without an increased 90-day complication profile attributable to either approach.
Abstract
Background
Morbidly obese (MO) patients undergoing total hip arthroplasty (THA) are at increased risk of postoperative complications. The effect of surgical approach on outcomes in this population remains unclear. This study compared perioperative outcomes and 90-day complications between direct anterior (DA) and postero-lateral (PL) approaches in MO and non-MO patients.
Methods
We retrospectively reviewed 5,933 primary THAs between January 2017 and March 2022. The surgeons included had performed at least 50 DA cases. Among 365 MO patients (body mass index [BMI] ≥ 40), 238 underwent DA and 127 underwent PL. Demographics, operative characteristics, and 90-day complications were analyzed. Multivariable logistic regressions adjusted for age, sex, BMI, American Society of Anesthesiology (ASA) class, and operative time; rare events were evaluated using penalized logistic regression. Propensity score-based sensitivity analyses were performed to account for confounders.
Results
In MO patients, operative times were significantly shorter with DA (71 ± 18 versus 92 ± 26 minutes, P < 0.001). On penalized multivariable analysis, there was a reduced risk of periprosthetic fracture for the DA group (OR [odds ratio] 0.08, 95% CI [confidence interval] 0.01 to 0.89); however, interpretation is limited by higher rates of cementation in the DA group. In sensitivity analysis, the risk of revision surgery remained significantly lower with DA (OR 0.31, 95% CI 0.11 to 0.85). Complication rates were otherwise statistically similar between approaches on adjusted analysis. Compared to non-MO patients, MO patients had longer operative times and higher overall complication rates, regardless of approach.
Conclusion
In MO patients undergoing THA, the DA approach was associated with shorter operative times. After multivariate adjustment, overall complication risks were similar between approaches across two analytical frameworks. These findings suggest that both DA and PL can be safely utilized in MO patients undergoing THA, without an increased 90-day complication profile attributable to either approach.