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

Abstract

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.

Keywords

Direct anterior approach posterior approach total hip arthroplasty wound complication;infection

Get full access to this article

View all access options for this article.

References

Ethgen

Bruyère

Richy

et al . Health-related quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature. J Bone Joint Surg Am 2004; 86: 963–974.

Judet

. Anterior approach in total hip arthroplasty. Presse Med 1985; 14: 1031–1033. [Article in French].

Smith-Peterson

. Approach to and exposure of the hip joint for mold arthroplasty. J Bone Joint Surg Am 1949; 31: 40–46.

Hueter

. Grundriss der Chirurgie, 2nd ed. Leipzig: FCW Vogel, 1883.

Chechik

Khashan

Lador

et al . Surgical approach and prosthesis fixation in hip arthroplasty world wide. Arch Orthop Trauma Surg 2013; 133: 1595–1600.

Goebel

Steinert

Schillinger

et al . Reduced postoperative pain in total hip arthroplasty after minimal-invasive anterior approach. Int Orthop 2012; 36: 491–498.

Nakata

Nishikawa

Yamamoto

et al . A clinical comparative study of the direct anterior with mini-posterior approach: two consecutive series. J Arthroplasty 2009; 24: 698–704.

Restrepo

Mortazavi

Brothers

et al . Hip dislocation: are hip precautions necessary in anterior approaches? Clin Orthop Relat Res 2011; 469: 417–422.

Zimmerli

Trampuz

Ochsner

. Prosthetic-joint infections. N Engl J Med 2004; 351: 1645–1654.

10.

Willis-Owen

Konyves

Martin

. Factors affecting the incidence of infection in hip and knee replacement: an analysis of 5277 cases. J Bone Joint Surg Br 2010; 92-B: 1128–1133.

11.

Christensen

Karthikeyan

Jacobs

. Greater prevalence of wound complications requiring reoperation with direct anterior approach total hip arthroplasty. J Arthroplasty 2014; 29: 1839–1841.

12.

Watts

Houdek

Wagner

et al . High risk of wound complications following direct anterior total hip arthroplasty in obese patients. J Arthroplasty 2015; 30: 2296–2298.

13.

Stinchfield

Cooperman

. Replacement of the femoral head by Judet or Austin Moore prosthesis. J Bone Joint Surg Am 1957; 39: 1043–1058.

14.

Namba

Inacio

Paxton

. Risk factors associated with surgical site infection in 30,491 primary total hip replacements. J Bone Joint Surg Br 2012; 94-B: 1330–1338.

15.

Wagner

Kamath

Fruth

et al . Effect of body mass index on complications and reoperations after total hip arthroplasty. J Bone Joint Surg Am 2016; 98: 169–179.

16.

Kennon

Keggi

Wetmore

et al . Total hip arthroplasty through a minimally invasive anterior surgical approach. J Bone Joint Surg Am 2003; 85(Suppl. 4): 39–48.

17.

Jewett

Collis

. High complication rate with anterior total hip arthroplasties on a fracture table. Clin Orthop Relat Res 2011; 469: 503–507.

18.

Vinden

Malthaner

McGee

et al . Teaching surgery takes time: the impact of surgical education on time in the operating room. Can J Surg 2016; 59: 87–92.

19.

Dodson

Craig

Cordasco

et al . Propionibacterium acnes infection after shoulder arthroplasty: a diagnostic challenge. J Shoulder Elbow Surg 2010; 19: 303–307.

20.

Singh

Sperling

Schleck

et al . Periprosthetic infections after total shoulder arthroplasty: a 33-year perspective. J Shoulder Elbow Surg 2012; 21: 1534–1541.

21.

Hahn

Zbinden

Min

. Late implant infections caused by Propionibacterium acnes in scoliosis surgery. Eur Spine J 2005; 14: 783–788.

22.

Rienmuller

Borens

. Propionibacterium prosthetic joint infection: experience from a retrospective database analysis. Eur J Orthop Surg Traumatol 2016; 26: 429–434.

23.

Smith

Sexton

Mann

et al . Sutures versus staples for skin closure in orthopaedic surgery: meta-analysis. BMJ 2010; 340: c1199.

24.

Burke

Green

McHugh

et al . A prospective randomised study comparing the jubilee dressing method to a standard adhesive dressing for total hip and knee replacements. J Tissue Viability 2012; 21: 84–87.

25.

Cai

Karam

Parvizi

et al . Aquacel surgical dressing reduces the rate of acute PJI following total joint arthroplasty: a case-control study. J Arthroplasty 2014; 29: 1098–1100.