Abstract
Introduction
The direct anterior (DA) approach for total hip arthroplasty has demonstrated successful short term outcomes. However, debate remains about which patients are candidates fo this approach. To our knowledge, there are no studies which specifically investigate short-term outcomes in obese versus non-obese patients undergoing THA through a DA approach. The purpose of this study was to evaluate complication rates and short term outcomes of obese, pre-obese, and normal BMI patients undergoing THA through DA approach.
Methods
A retrospective review of 151 consecutive patients who underwent unilateral THA through a DA approach for osteoarthritis or avascular necrosis was performed after IRB approval. Forty patients had a normal BMI, 54 were pre-obese, and 57 were obese by WHO classification (37 class I obese, 12 class II obese, and 8 class III obese). Electronic and paper charts were reviewed to determine differences in surgical time, length of stay, disposition, wound and major complications, and short term outcome measures.
Results
When comparing normal and pre-obese patients to a combined group of WHO class I, II, and III obese patients, surgical time was increased by 15.8 minutes (P <0.0001), narcotic use was increased at two weeks (P=0.0242), and assistive device use was increased at 2 weeks (P=0.0079) in the obese patient group. There were trends toward increased wound complications in obese patients, 14.3% vs 4.2% (P=0.0569), increased major complications, 7.1% vs 1.1% (P=0.0633), and a higher use of rehabilitation facilities, 20.0% vs 9.5% (p=0.0676).
Conclusions
This study demonstrated significantly increased surgical time and higher use of narcotics and assistive devices in obese patients. Trends toward increased wound and major complications, and a higher likelihood of rehabilitation placement were found. This study helps determine appropriate candidates for THA through a DA approach as obese patients may have more complicated postoperative courses.
