The Safety and Efficacy of the Anterior Approach Total Hip Arthroplasty as per Body Mass Index

Abstract

Background: Obesity is associated with component malpositioning and increased revision risk after total hip arthroplasty (THA). With anterior approaches (AAs) becoming increasingly popular, the goal of this study was to assess whether clinical outcome post-AA-THA is affected by body mass index (BMI). Methods: This multicenter, multisurgeon, consecutive case series used a prospective database of 1,784 AA-THAs (1,597 patients) through bikini (n = 1,172) or standard (n = 612) incisions. Mean age was 63 years (range, 20-94 years) and there were 57.5% women, who had a mean follow-up of 2.7 years (range, 2.0-4.1 years). Patients were classified into the following BMI groups: normal (BMI < 25.0; n = 572); overweight (BMI: 25.0-29.9; n = 739); obese (BMI: 30.0-34.9; n = 330); and severely obese (BMI similar to 35.0; n = 143). Outcomes evaluated included hip reconstruction (inclination/anteversion and leg-length, complications, and revision rates) and patient-reported outcomes including Oxford Hip Scores (OHS). Results: Mean postoperative leg-length difference was 2.0 mm (range: similar to 17.5 to 39.0) with a mean cup inclination of 34.8 similar to (range, 14.0-58.0 similar to) and anteversion of 20.3 similar to (range, 8.0-38.6 similar to). Radiographic measurements were similar between BMI groups (P =.1-.7). Complication and revision rates were 2.5% and 1.7%, respectively. The most common complications were fracture (0.7%), periprosthetic joint infection (PJI) (0.5%), and dislocation (0.5%). There was no difference in dislocation (P =.885) or fracture rates (P =.588) between BMI groups. There was a higher rate of wound complications (1.8%; P =.053) and PJIs (2.1%; P =.029) among obese and severely obese patients. Wound complications were less common among obese patients with the `bikini' incision (odds ratio 2.7). Preoperative OHS was worse among the severely obese (P <.001), which showed similar improvements (Change in OHS; P =.144). Conclusion: AA-THA is a credible option for obese patients, with low dislocation or fracture risk and excellent ability to reconstruct the hip, leading to comparable functional improvements among BMI groups. Obese patients have a higher risk of PJIs. Bikini incision for AA-THA can help minimize the risk of wound complications.