Increased Complications in Obese Patients Undergoing Direct Anterior Total Hip Arthroplasty

Russo, Matthew; MacDonell, Jacquelyn; Paulus, Megan Carroll; Jarod, Keller; Zawadsky, Mark W.

doi:10.1016/j.arth.2015.03.002

Cited by 74 publications

(55 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In patients with DAA, an incidence of up to 3 % is described [13, 25]. Because patients undergoing debridement without exchange of mobile parts, as well as those with exclusive suppressive therapy might not appear in registers, the published infection rates may be underestimated [1].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Risk of infection in primary, elective total hip arthroplasty with direct anterior approach or lateral transgluteal approach: a prospective cohort study of 1104 hips

Ilchmann

Zimmerli

Bolliger

et al. 2016

BMC Musculoskelet Disord

View full text Add to dashboard Cite

BackgroundThe direct anterior approach (DAA) is increasingly popular for hip replacement. However, the small incision and the location near to the groin might increase the risk of periprosthetic joint infection (PJI). We asked the questions (i) whether there is an increased risk of infection for this approach, and (ii) whether the spectrum of microorganisms differs between patients with DAA and those with lateral transgluteal approach (LAT).MethodsAll patients operated between 08/2006 and 12/2013 were followed prospectively in an in house register. The DAA was introduced as routine in 02/2009 at our hospital. Patients with primary elective hip replacement without previous operations were included. Follow-up was scheduled after 6, 12 weeks and 1, 2 years. PJI was defined according to standardized criteria.ResultsOne thousand one hundred four patients were studied, 700 were operated with DAA and 404 with LAT. No patient was lost to follow-up. PJI was diagnosed in 23/1104 (2.1 %) patients, 16 (2.3 %) in the group with DAA, and 7 (1.7 %) in the group with LAT. Patients with infection had a higher BMI (p < 0.001) and a higher ASA score (p < 0.001). Only patients with the DAA had exogenous PJI caused by gramnegative bacilli (35.7 % vs 0 %, p = 0.26). In the DAA-group, the fraction of patients with polymicrobial infection was somewhat higher than in the LAT-group (50 % vs 33 %, P = 0.64).ConclusionThere was no increased risk of infection for the DAA.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Furthermore, aiming to shorter incisions might be a potential risk of increased skin irritation by traction and by surgical instruments. This might cause problems with wound healing or contamination of the implant with consecutive PJI [11–13]. …”

Section: Introductionmentioning

confidence: 99%

Risk of infection in primary, elective total hip arthroplasty with direct anterior approach or lateral transgluteal approach: a prospective cohort study of 1104 hips

Ilchmann

Zimmerli

Bolliger

et al. 2016

BMC Musculoskelet Disord

View full text Add to dashboard Cite

show abstract

“…One of the most important considerations in the adoption of any new surgical approach is what the learning curve is for the procedure, and we opted to exclude patients who had surgery during this time from the study to see what the differences were between the approaches after sufficient experience. However, others [16,47] have found higher rates of complications with this approach during the early period of use, with complications including fracture, lateral femoral cutaneous nerve palsy, and much higher blood loss [6,39,47]. The surgeon (IMT) at our institution was an arthroplasty fellowship-trained surgeon with 7 to 8 years of experience at the start of the study, therefore his learning curve may have been shorter with less complications than for lower-volume surgeons with less arthroplasty experience.…”

Section: Discussionmentioning

confidence: 99%

“…Numerous authors have reported low dislocation rates and rapid early functional recovery [1,29,31,33,36,40,46] with this approach. However, some studies have shown higher surgical blood loss and complication rates [6,47], particularly for less-experienced surgeons [16,43] or for patients who are obese [39]. Additionally, the distal extension of the approach is less familiar to most surgeons and a recent anatomic study by Grob et al [10] suggested that it may pose a risk to the neurovascular supply to portions of the vastus lateralis.…”

Section: Introductionmentioning

confidence: 99%

Does Surgical Approach Affect Patient-reported Function After Primary THA?

Graves

Dropkin

Keeney

et al. 2016

Clinical Orthopaedics &Amp; Related Research

117

View full text Add to dashboard Cite

Background Total hip arthroplasty (THA) relieves pain and improves physical function in patients with hip osteoarthritis, but requires a year or more for full postoperative recovery. Proponents of intermuscular surgical approaches believe that the direct-anterior approach may restore physical function more quickly than transgluteal approaches, perhaps because of diminished muscle trauma. To evaluate this, we compared patient-reported physical function and other outcome metrics during the first year after surgery between groups of patients who underwent primary THA either through the direct-anterior approach or posterior approach. Questions/purposes We asked: (1) Is a primary THA using a direct-anterior approach associated with better patient-reported physical function at early postoperative times (1 and 3 months) compared with a THA performed through the posterior approach? (2) Is the direct-anterior approach THA associated with shorter operative times and higher rates of noninstitutional discharge than a posterior approach THA? Methods Between

show abstract

“…However, not all authors described their learning curve, and whether their early experiences were included in their study is unclear. Several studies of early experiences with the DAA clearly demonstrated higher complication rates [6,7,15,16]. We strongly believe that the DAA has a great value for primary THA, as described by many authors [3,4,14]; however, this technique has a clear learning curve that must be balanced with its benefits.…”

Section: Discussionmentioning

confidence: 94%

Greater trochanter chip fractures in the direct anterior approach for total hip arthroplasty

Homma

Baba

Ochi

et al. 2016

Eur J Orthop Surg Traumatol

View full text Add to dashboard Cite

show abstract

Increased Complications in Obese Patients Undergoing Direct Anterior Total Hip Arthroplasty

Cited by 74 publications

References 22 publications

Risk of infection in primary, elective total hip arthroplasty with direct anterior approach or lateral transgluteal approach: a prospective cohort study of 1104 hips

Risk of infection in primary, elective total hip arthroplasty with direct anterior approach or lateral transgluteal approach: a prospective cohort study of 1104 hips

Does Surgical Approach Affect Patient-reported Function After Primary THA?

Greater trochanter chip fractures in the direct anterior approach for total hip arthroplasty

Contact Info

Product

Resources

About