Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota.
J Arthroplasty. 2024 Sep;39(9S2):S459-S463. doi: 10.1016/j.arth.2024.03.047. Epub 2024 Mar 26.
Previous studies have suggested that wound complications may differ by surgical approach after total hip arthroplasty (THA), with particular attention toward the direct anterior approach (DAA). However, there is a paucity of data documenting wound complication rates by surgical approach and the impact of concomitant patient factors, namely body mass index (BMI). This investigation sought to determine the rates of wound complications by surgical approach and identify BMI thresholds that portend differential risk.
This multicenter study retrospectively evaluated all primary THA patients from 2010 to 2023. Patients were classified by skin incision as having a laterally based approach (posterior or lateral approach) or DAA (longitudinal incision). We identified 17,111 patients who had 11,585 laterally based (68%) and 5,526 (32%) DAA THAs. The mean age was 65 years (range, 18 to 100), 8,945 patients (52%) were women, and the mean BMI was 30 (range, 14 to 79). Logistic regression and cut-point analyses were performed to identify an optimal BMI cutoff, overall and by approach, with respect to the risk of wound complications at 90 days.
The 90-day risk of wound complications was higher in the DAA group versus the laterally based group, with an absolute risk of 3.6% versus 2.6% and a multivariable adjusted odds ratio of 1.5 (P < .001). Cut-point analyses demonstrated that the risk of wound complications increased steadily for both approaches, but most markedly above a BMI of 33.
Wound complications were higher after longitudinal incision DAA THA compared to laterally based approaches, with a 1% higher absolute risk and an adjusted odds ratio of 1.5. Furthermore, BMI was an independent risk factor for wound complications regardless of surgical approach, with an optimal cut-point BMI of 33 for both approaches. These data can be used by surgeons to help consider the risks and benefits of approach selection.
Level III.
先前的研究表明，全髋关节置换术（THA）后手术入路可能会导致不同的伤口并发症，尤其需要关注直接前入路（DAA）。然而，目前关于手术入路导致伤口并发症发生率的数据很少，也没有研究伴随患者因素（即体重指数（BMI））的影响。本研究旨在确定手术入路导致伤口并发症的发生率，并确定预示不同风险的 BMI 阈值。
这项多中心研究回顾性评估了 2010 年至 2023 年所有初次 THA 患者。患者根据皮肤切口分为外侧入路（后路或外侧入路）或 DAA（纵行切口）。我们确定了 17111 例外侧入路（68%）和 5526 例 DAA（32%）THA。患者平均年龄为 65 岁（范围 18 至 100 岁），8945 例（52%）为女性，平均 BMI 为 30（范围 14 至 79）。进行逻辑回归和切点分析，以确定 90 天伤口并发症风险的最佳 BMI 切点，整体和按入路分别进行分析。
DAA 组 90 天伤口并发症风险高于外侧入路组，绝对风险为 3.6%对 2.6%，多变量调整比值比为 1.5（P<0.001）。切点分析表明，两种方法的伤口并发症风险均呈稳步上升趋势，但在 BMI 超过 33 后上升更为明显。
与外侧入路相比，DAA 纵向切口 THA 后的伤口并发症发生率更高，绝对风险增加 1%，调整后的比值比为 1.5。此外，BMI 是伤口并发症的独立危险因素，与手术入路无关，两种方法的最佳 BMI 切点均为 33。这些数据可以帮助外科医生考虑入路选择的风险和获益。
3 级。
