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

Abstract

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.

Timing of hip hemiarthroplasty and the influence on prosthetic joint infection

“…This rate of PJI is consistent with two systematic reviews which have reported an average risk of PJI after hip arthroplasty for the treatment of a hip fracture between 2-4% [10], [11]. This is a higher rate of PJI than the 0.5-2% PJI rate typically found in the primary elective hip arthroplasty population [24], [25]. It is unsurprising that hip fracture patients have higher rates of PJI than the elective hip arthroplasty population given the increased age, poor nutritional status, and large number of comorbidities of hip fracture patients [26].…”

Association of Cutibacterium avidum Colonization in the Groin With Obesity: A Potential Risk Factor for Hip Periprosthetic Joint Infection

“…We cannot make a statement about the risk for C. avidum PJI in colonized patients since we only have a follow-up of 6 to 12 months after primary hip arthroplasty in 21 colonized patients. In general, the anterior approach is not seen as a risk factor for infections [29]. However, obesity, defined as an elevated BMI, is a known general risk factor for PJIs [29][30][31].…”

Transitioning to the direct anterior approach in total hip arthroplasty. Is it a true muscle sparing approach when performed by a low volume hip replacement surgeon?

“…One of the limitations is related to the complications that might occur later in time, although a recent Bayesian metaanalysis study [25] that analysed 38 studies (6485 patients) reported that most complications relative to the approach occur in the early post-operative settings. Moreover, a prospective cohort study of 1104 hip arthroplasties carried out by Ilchmann et al [27] comparing the short and long term risks of infection between the two approaches also reported no increased risk for the DAA. Therefore, we consider our follow-up period to be sufficient to detect approach-related complications.…”

“…By the current study we had no intention to compare either the short term or long term clinical outcomes by means of hip and quality of life scores, as this has been widely dissected by previous studies, with a virtually unanimous conclusion of no long term difference, regardless of objectified muscle spearing findings [6,7,15,27].…”