Abdominal Pannus Should Not Dictate Surgical Approach in Primary Total Hip Arthroplasty

Increased pannus size is a risk factor for complications with anterior approach total hip arthroplasty (THA). However, it is unclear if changing to a posterior approach mitigates this risk. The purpose of this study was to evaluate whether abdominal pannus size had a differential effect on complication rate comparing anterior vs posterior THA.

One thousand consecutive primary THA patients-478 anterior and 522 posterior-were retrospectively reviewed for complications and their abdominal pannus was radiographically measured on an anteroposterior pelvis image and placed into 1 of 4 categories based on its vertical size (no pannus [G0], above symphysis [G1], below symphysis [G2], or below ischial tuberosities [G3]). Chi-squared tests for univariate and logistic regression models controlled for age, race, gender, body mass index, Charlson comorbidity index, and smoking.

Comparing wound complications at increasing pannus size, anterior vs posterior (G0 1.9% vs 3.9%, P = .21; G1 7.2% vs 6.7%, P = .08; G2 17.9% vs 11.6%, P = .27; G3 16.7% vs 15.5%, P = .84), similar results were found with reoperations (G0 0.9% vs 1.1%, P = .080; G1 1.4% vs 2%, P = .72; G2 3.0% vs 5.8%, P = .41; G3 1.7% vs 4.5%, P = .33). Additionally, logistic regression models demonstrated no statistically significant difference in the odds of wound complications or reoperations between the approaches at each pannus size.

In patients with an abdominal pannus, there is no difference in the risk of delayed wound healing or reoperation within 90 postoperative days comparing anterior to posterior approach.