Influence of surgical approach on complication risk in primary total hip arthroplasty

Area of Science:

• Orthopedic Surgery
• Biomechanical Engineering
• Clinical Epidemiology

Background:

• Systematic comparisons of anterior (A) versus posterior (P) approaches in primary total hip arthroplasty (THA) have primarily focused on perioperative outcomes.
• Long-term complication risks associated with these approaches require further investigation.

Purpose of the Study:

• To systematically compare the complication risks between anterior (A) and posterior (P) approaches in primary total hip arthroplasty (THA).
• To analyze complication rates including infection, dislocation, reoperation, thromboembolic events, heterotopic ossification, wound complications, fractures, and nerve injuries with at least a 1-year mean follow-up.

Main Methods:

• A systematic review and meta-analysis of prospective and retrospective studies reporting complications for primary THA using A or P approaches.
• Included studies had a minimum 1-year mean follow-up.
• Random effects meta-analysis was employed to calculate rate ratios (RR) for complication risks.

Main Results:

• Nineteen studies comprising 6,620 patients (A: 2,278; P: 4,342) from single-center studies and 157,687 patients (A: 18,735; P: 138,952) from multicenter registries were analyzed.
• The anterior approach demonstrated a significantly lower rate of infection (RR=0.55), dislocation (RR=0.65), and reoperation (RR=0.84).
• A higher rate of patient-reported nerve injury was observed with the anterior approach (RR=2.3), while no significant differences were found for thromboembolic events, heterotopic ossification, wound complications, or fractures.

Conclusions:

• The anterior approach in primary total hip arthroplasty is associated with reduced risks of infection, dislocation, and reoperation.
• Surgeons should be aware of the increased risk of patient-reported nerve injury with the anterior approach when selecting a surgical technique for primary THA.