Does Surgical Approach for Total Hip Arthroplasty Impact Infection Risk in the Obese Patient? A Systematic Review

Area of Science:

• Orthopedics
• Surgical Outcomes
• Infectious Disease

Background:

• Periprosthetic joint infection (PJI) is a significant complication following total hip arthroplasty (THA).
• Obesity is a known risk factor for surgical site infections, but its interaction with different THA surgical approaches requires further clarification.

Purpose of the Study:

• To systematically review the combined effects of patient body mass index (BMI) and surgical approach on PJI rates after THA.
• To identify specific BMI thresholds and surgical techniques associated with increased PJI risk.

Main Methods:

• Systematic review of existing literature on THA, obesity, surgical approach, and PJI.
• Analysis of PJI and wound complication rates stratified by BMI categories and surgical approaches (direct anterior, posterior, anterolateral).

Main Results:

• Elevated PJI and wound complication rates were observed with the direct anterior approach (DAA) in patients with BMI ≥30 kg/m² and ≥35 kg/m², respectively.
• A BMI ≥30 kg/m² also increased PJI risk with the posterior approach.
• No increased PJI risk was found for the anterolateral approach in patients with BMI ≥30 kg/m².

Conclusions:

• Elevated BMI (≥30 kg/m²) is a general risk factor for PJI in THA, irrespective of the surgical approach.
• Patients undergoing DAA THA with a BMI ≥35 kg/m² may face a higher PJI risk compared to other approaches.