|Beitragstitel||The direct anterior approach for total hip arthroplasty in the severe obese patient. Is it a reliable option for patients with a BMI > 35 kg/m²?|
Severe obese patients (BMI>35 kg/m²) requiring total hip arthroplasty (THA) are not considered good candidates for direct anterior approach (DAA) as excessive abdominal fat tissue can impede surgery thus increasing the potential for complications. The advantages of the DAA in THA are well known, however the concerns about applying these techniques in obese patients remain controversial. The aim of this study, was to determine if the DAA is a reliable option in severe obese patients in terms of complications and outcome.
In this retrospective cohort study we included 141 patients (80 female, 61 male) with a median BMI of 42 kg/m² (range 35 – 56) who underwent primary THA through a DAA in our department from January 2009 to December 2015. Median age was 69 years (range, 45 – 91) and median follow-up time 3.2 years (range, 1 – 5). As control group acted 285 patients (129 female, 156 male), with a median BMI of 23.6 kg/m² (range 20 - 25) and median age of 72y (range 61 - 94) who had surgery in the same time period. Median follow up time was 2.6y (range 1 -5). Intraoperative data, peri- and postoperative complications, radiographic values and hip function (Harris Hip Score) were assessed.
In the severe obese group 10 hip infections (7.8%) were recorded until last follow up time. 20 patients required revision surgery (14%). Median hospital stay was 13.2 days. 3 patients deceased during follow up. In one case death was related to hip infection. The median Harris Hip score (HHS) improved from 61 (range 35 - 70) to 87 points (range 74 – 100). The infection rate in the control group was 1.7%. 12 patients required revision surgery (4.2%). Median hospital stay was 6.2 days. The median HHS improved from 62 (range 40 - 74) to 91 points (range 78 -100). 4 patients deceased during follow up. No death was linked to the surgical treatment. No dislocation was observed during follow up time in both groups.
Our data suggest that severe obese patients have significantly higher infection rates compared to non obese patients. However, compared to literature our infection rates with the DAA are comparable to standard more extensive approaches. Severe obese patients can still profit from the benefits of DAA as do non-obese patients. The results of this study should be further investigated to assess long-term effects.