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

Chrysoula Argyrou; Dimitrios Tzefronis; Michail Sarantis; Konstantinos Kateros; Lazaros Poultsides; George A Macheras

doi:10.1302/2633-1462.31.BJO-2021-0166.R1

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

Bone Jt Open. 2022 Jan;3(1):4-11. doi: 10.1302/2633-1462.31.BJO-2021-0166.R1.

Authors

Chrysoula Argyrou¹, Dimitrios Tzefronis¹, Michail Sarantis¹, Konstantinos Kateros², Lazaros Poultsides^{3

4}, George A Macheras¹

Affiliations

¹ 4th Department of Orthopaedic Surgery and Traumatology, KAT Attica General Hospital, Athens, Greece.
² 1st Orthopaedic Department, Gennimatas General Hospital, Athens, Greece.
³ Academic Orthopaedic Department, Papageorgiou General Hospital, Aristotle University Medical School, Thessaloniki, Greece.
⁴ Centre of Orthopaedics and Regenerative Medicine (C.O.R. E.) and Centre of Interdisciplinary Research and Innovation (C. I. R. I.), Aristotle University, Thessaloniki, Greece.

PMID: 34985307
PMCID: PMC9047080
DOI: 10.1302/2633-1462.31.BJO-2021-0166.R1

Abstract

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.

Keywords: BMI; Direct anterior approach; Hip; Morbid obesity; Morbidly obese; Obesity; Total hip arthroplasty; direct anterior approach; periprosthetic joint infection (PJI); postoperative complications; reoperations; superficial wound infections; total hip arthroplasty (THA).