Incision site fat thickness and 90-day complications for direct anterior and posterior approach total hip...

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 (n = 60) and the lateral incision site (LT-IS) of the PA (n = 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.