Russo Matthew W, Macdonell J Ryan, Paulus Megan C, Keller Jarod M, Zawadsky Mark W
Department of Orthopaedic Surgery, MedStar Georgetown University Hospital, Washington, DC.
Department of Orthopaedic Surgery, Georgetown University School of Medicine, Washington, DC.
J Arthroplasty. 2015 Aug;30(8):1384-7. doi: 10.1016/j.arth.2015.03.002. Epub 2015 Mar 17.
The direct anterior (DA) approach for total hip arthroplasty (THA) has demonstrated successful short term outcomes in several studies. However, there is no consensus about which patients are appropriate candidates for DA total hip arthroplasty. It is also unclear if short term outcomes in obese patients undergoing THA through a DA approach are elevated in comparison to non-obese patients. The purpose of this study was to evaluate complication rates and short term outcomes of obese, pre-obese, and normal body mass index (BMI) patients undergoing THA with a DA approach in a consecutive group of patients. This study was a retrospective review of 210 consecutive patients who underwent unilateral THA through a DA approach for osteoarthritis or avascular necrosis during the early peri-operative period. The study included 61 patients with normal BMI, 70 pre-obese patients, and 79 obese patients according to World Health Organization (WHO) classification (49 class I obese, 22 class II obese, and 8 class III obese patients). Patient charts were reviewed to determine differences in surgical time, length of stay, disposition, major complications, wound complications, and short term outcome measures. When comparing normal and pre-obese patients (BMI <30) to a combined group of WHO class I, II, and III obese patients (BMI >30), the obese group demonstrated increased surgical times by 12.7 minutes (P<0.0001), as well as increased length of stay (P=0.0303), narcotic use (P=0.0037), and assistive device use at two weeks (P<0.0030). In addition, major complications and wound complications were both significantly increased in the obese group (odds ratio [OR], 8.8; P=0.0493 and OR, 3.6; P=0.0431, respectively). There was also a trend toward increased use of rehabilitation facilities in the obese group at disposition, 15.4% vs 7.6% (P=0.0774). This study demonstrates that obese patients undergoing a DA approach have a 8.8 and 3.6 times increase in major and wound complications, respectively, compared to patients with a BMI <30. Obese patients also demonstrated significant increases in operative time, use of narcotics, use of assistive devices, and length of stay. There was a trend toward higher use of rehabilitation placement. While significant, these findings are similar to complication rates in the literature for other THA operative approaches. This study further defines the risks associated with performing THA on obese patients regardless of approach.
在多项研究中，全髋关节置换术（THA）的直接前路（DA）入路已显示出良好的短期效果。然而，对于哪些患者适合采用DA全髋关节置换术，目前尚无共识。同样不清楚的是，与非肥胖患者相比，通过DA入路接受THA的肥胖患者的短期效果是否更好。本研究的目的是评估连续一组采用DA入路接受THA的肥胖、超重前期和正常体重指数（BMI）患者的并发症发生率和短期效果。本研究是一项对210例连续患者的回顾性分析，这些患者在围手术期早期通过DA入路接受了单侧THA，病因是骨关节炎或股骨头缺血性坏死。根据世界卫生组织（WHO）分类，该研究纳入了61例BMI正常的患者、70例超重前期患者和79例肥胖患者（49例I级肥胖、22例II级肥胖和8例III级肥胖患者）。查阅患者病历以确定手术时间、住院时间、出院情况、主要并发症、伤口并发症和短期效果指标的差异。将BMI正常和超重前期患者（BMI<30）与WHO I、II和III级肥胖患者合并组（BMI>30）进行比较时，肥胖组的手术时间增加了12.7分钟（P<0.0001），住院时间（P=0.0303）、麻醉药物使用（P=0.0037）和术后两周辅助器械使用（P<0.0030）也有所增加。此外，肥胖组的主要并发症和伤口并发症均显著增加（优势比[OR]分别为8.8；P=0.0493和OR为3.6；P=0.0431）。肥胖组出院时使用康复设施的比例也有增加趋势，为15.4%，而BMI<30的患者为7.6%（P=0.0774）。本研究表明，与BMI<30的患者相比，采用DA入路的肥胖患者发生主要并发症和伤口并发症的风险分别增加8.8倍和3.6倍。肥胖患者的手术时间、麻醉药物使用、辅助器械使用和住院时间也显著增加。康复安置的使用有增加趋势。虽然这些结果具有统计学意义，但与文献中其他THA手术入路的并发症发生率相似。本研究进一步明确了无论采用何种入路，肥胖患者接受THA所面临的风险。
