Anderson Orthopaedic Research Institute, Alexandria, Virginia; Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland.
Anderson Orthopaedic Research Institute, Alexandria, Virginia.
J Arthroplasty. 2018 Jan;33(1):220-223. doi: 10.1016/j.arth.2017.07.047. Epub 2017 Aug 4.
The purpose of this study was to compare the posterior approach (PA) with the direct anterior approach (DAA) among obese and nonobese total hip arthroplasty patients to determine if obese DAA patients have a higher risk of infection or wound complications compared with obese PA patients.
We retrospectively evaluated 4651 primary total hip cases performed via anterior approach or PA between 2009 and 2015. Patients were divided into 4 study groups based on approach and body mass index (BMI): (1) DAA <35 kg/m, (2) DAA ≥35 kg/m, (3) PA <35 kg/m, and (4) PA ≥35 kg/m. Infection rates and wound complications were compared.
The rate of deep infection in groups 1 and 3 (nonobese anterior vs posterior) was 0.28% and 0.36%, respectively (P = .783); and in groups 2 and 4 (obese anterior vs posterior) was 2.35% and 2.7%, respectively (P = .80). The rate of wound complications between groups 1 and 3 (nonobese) was 1.0% and 0.3%, respectively (P = .005). Between groups 2 and 4 (obese), the rates of complications were 1.7% and 1.4%, respectively (P = 1.0). There was no difference in reoperation rates for wounds between groups 1 and 3 or between groups 2 and 4 (P = .217, P = .449).
In the largest available series, there was no difference in deep infection rates between the 2 approaches. In the subset of obese patients with BMI ≥35 kg/m, there was no increased risk of deep infection or wound complications in DAA patients compared with PA patients. However, anterior hip cases experienced higher rates of superficial wound complications compared with posterior cases across all BMIs.
本研究旨在比较肥胖和非肥胖全髋关节置换患者的后入路（PA）与直接前入路（DAA），以确定与肥胖 PA 患者相比，肥胖 DAA 患者的感染或伤口并发症风险是否更高。
我们回顾性评估了 2009 年至 2015 年间通过前路或 PA 进行的 4651 例初次全髋关节病例。根据入路和体重指数（BMI）将患者分为 4 个研究组：（1）DAA <35kg/m，（2）DAA ≥35kg/m，（3）PA <35kg/m，和（4）PA ≥35kg/m。比较感染率和伤口并发症。
组 1 和 3（非肥胖前路与后路）深部感染率分别为 0.28%和 0.36%（P =.783）；组 2 和 4（肥胖前路与后路）分别为 2.35%和 2.7%（P =.80）。组 1 和 3（非肥胖）之间的伤口并发症发生率为 1.0%和 0.3%（P =.005）。组 2 和 4（肥胖）之间的并发症发生率分别为 1.7%和 1.4%（P = 1.0）。组 1 和 3 或组 2 和 4 之间的伤口再手术率无差异（P =.217，P =.449）。
在最大的可用系列中，两种方法的深部感染率没有差异。在 BMI ≥35kg/m 的肥胖患者亚组中，与 PA 患者相比，DAA 患者的深部感染或伤口并发症风险没有增加。然而，在前路髋关节病例中，所有 BMI 中都比后路病例发生更高的浅表伤口并发症发生率。
