Sprowls Gregory R, Allen Bryce C, Lundquist Kathleen F, Sager Lauren N, Barnett Clint D
Department of Orthopaedic Surgery, Baylor Scott & White Health, Temple, TX, USA.
College of Medicine, Texas A&M Health Science Center, Temple, TX, USA.
Hip Int. 2022 Jul;32(4):431-437. doi: 10.1177/1120700020977166. Epub 2020 Dec 9.
Defining the distribution of subcutaneous fat around the hip in relation to different approaches for total hip arthroplasty (THA) may lead to a better understanding of the relationship between obesity and complications. The purpose of this study was to: (1) describe the intraoperative thickness of subcutaneous fat at the incision site for direct anterior (DAA) and posterior approaches (PA) for THA; and (2) examine the relationship between fat thickness and 90-day postoperative complications.
Intraoperative fat measurements were obtained at the anterior incision site (AT-IS) of the DAA ( = 60) and the lateral incision site (LT-IS) of the PA ( = 64). Lateral hip fat thickness was measured from preoperative anteroposterior pelvis radiographs (LT-XR). Body mass index (BMI), sex, age, and 90-day complications were collected retrospectively.
Patients within the same demographic groupings had significantly more fat laterally than anteriorly, between 9.6 mm and 17.96 mm. Return to the OR was significantly associated with BMI, AT-IS, and LT-IS. Wound complications were significantly associated with AT-IS. Periprosthetic joint infection (PJI) was significantly associated with BMI and LT-IS. No outcome variables were associated with LT-XR, approach, sex, or age. LT-XR was strongly correlated with AT-IS and LT-IS.
Regardless of BMI, sex, or age more soft tissue was encountered with a PA compared to a DAA. General adiposity was associated with return to the OR. Excess incisional fat was associated with wound complications following a DAA and PJI after a PA. LT-XR and clinical examination near the proposed incision, may provide helpful data in making preoperative risk assessments.
明确髋关节周围皮下脂肪分布与全髋关节置换术（THA）不同手术入路的关系，可能有助于更好地理解肥胖与并发症之间的关联。本研究的目的是：（1）描述THA直接前路（DAA）和后路（PA）手术切口部位皮下脂肪的术中厚度；（2）研究脂肪厚度与术后90天并发症之间的关系。
在DAA的前切口部位（AT-IS，n = 60）和PA的外侧切口部位（LT-IS，n = 64）进行术中脂肪测量。通过术前骨盆前后位X线片（LT-XR）测量髋关节外侧脂肪厚度。回顾性收集体重指数（BMI）、性别、年龄和90天并发症情况。
在相同人口统计学分组中，患者外侧脂肪明显多于前侧，相差9.6毫米至17.96毫米。返回手术室与BMI、AT-IS和LT-IS显著相关。伤口并发症与AT-IS显著相关。假体周围关节感染（PJI）与BMI和LT-IS显著相关。没有结果变量与LT-XR、手术入路、性别或年龄相关。LT-XR与AT-IS和LT-IS密切相关。
无论BMI、性别或年龄如何，与DAA相比，PA手术遇到的软组织更多。总体肥胖与返回手术室相关。切口脂肪过多与DAA术后伤口并发症和PA术后PJI相关。LT-XR以及拟切口附近的临床检查，可能为术前风险评估提供有用数据。
