The effect of surgical approach on early complications of total hip arthroplasty
Kenny Tay1,2, Andrew Tang3, Camdon Fary3
1Arthroplasty Fellow, Epworth Musculoskeletal Clinical Institute, 89 Bridge Road, Richmond, Melbourne, VIC, 3121, Australia. Kenny.tay@mohh.com.sg.
Insights
Total hip arthroplasty (THA) complication rates are similar across anterior, direct lateral, and posterior approaches. Surgeons should monitor for approach-specific issues like anterior fractures and posterior dislocations.
Area of Science:
- Orthopedic Surgery
- Arthroplasty
- Surgical Outcomes
Background:
- Total hip arthroplasty (THA) is a common procedure with generally low complication rates.
- Complications such as infection, fracture, and dislocation can necessitate readmission or reoperation.
- Understanding approach-specific complication rates is crucial for optimizing patient outcomes.
Purpose of the Study:
- To compare the complication rates of anterior, direct lateral, and posterior surgical approaches in total hip arthroplasty.
- To identify specific complications associated with each surgical approach.
Main Methods:
- A retrospective review of 2437 THAs performed between July 1, 2014, and June 30, 2016, at Epworth Healthcare.
- Data was collected from hospital databases and the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR).
- Complications, including peri-prosthetic fractures, dislocations, implant subsidence, and infections, were identified and analyzed by surgical approach.
Main Results:
- Peri-prosthetic fractures occurred in 29 hips (13 anterior, 9 lateral, 7 posterior), with a statistically significant increase in revision rates for the anterior approach.
- Fourteen dislocations were recorded (5 anterior, 1 lateral, 8 posterior), with 8 requiring revision.
- Infections occurred in 12 cases (2 anterior, 4 lateral, 6 posterior), with 6 necessitating implant revision.
Conclusions:
- Overall complication rates for THA are similar across anterior, direct lateral, and posterior approaches.
- Surgeons must remain vigilant for approach-specific complications, such as femoral fractures with the anterior approach and dislocations with the posterior approach.
- Tailoring vigilance to the specific surgical approach can help mitigate unique risks and improve patient safety.
Background:
Total hip arthroplasty (THA) is traditionally associated with a low complication rate, with complications such as infection, fracture and dislocation requiring readmission or reoperation. We seek to identify the complication rate among the anterior, direct lateral and posterior surgical approaches.
Methods:
We reviewed all THAs performed at the Epworth Healthcare from 1 July 2014 to 30 June 2016. There were 2437 THAs performed by a variety of approaches. No hips were excluded from this study. We surveyed the hospital database and the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) to identify those patients who had been readmitted and/or reoperated on. Details collected included age, gender, laterality of the surgery (left/right/bilateral), surgical approach utilised, complications which occurred.
Results:
There were 29 peri-prosthetic fractures detected (13 anterior, 9 lateral, 7 posterior) and 10 underwent revision of implant, 19 were fixed. The increased rate of revision in the anterior group was statistically significant. There were 14 dislocations (5 anterior, 1 lateral, 8 posterior) of which 8 prostheses were revised. Three cases operated via the anterior approach and 1 by the lateral had early subsidence without fracture, necessitating revision of the femoral prostheses. Operative site infection occurred in 12 cases (2 anterior, 4 lateral, 6 posterior) with 6 requiring revision of implants.
Conclusion:
The complication rates between the 3 main approaches are similar, but individual surgeons should be vigilant for complications unique to their surgical approaches, such as femoral fractures in the anterior approach and dislocations in the posterior approach.
