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

This systematic review evaluated the combined effects of obesity and surgical approach on periprosthetic joint infection (PJI) rates after total hip arthroplasty (THA). Wound complication and PJI rates were elevated among patients with body mass index (BMI) of 30 kg/m² or greater and 35 kg/m² or greater, respectively, with the direct anterior approach (DAA). A BMI of 30 kg/m² or greater also increased the risk of PJI with the posterior approach. Patients with BMI of 30 kg/m² or greater undergoing anterolateral approach THA did not have increased risk of PJI. Patients with elevated BMI (≥30 kg/m²) are at risk for PJI, regardless of approach. Patients undergoing DAA THA who have BMI of 35 kg/m² or greater may have an increased risk of PJI compared with those undergoing THA with other approaches. [Orthopedics. 2022;45(2):e67-e72.].