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Reduced Wound Complications With Absorbable Deep Dermal Staples in Direct Anterior Total Hip Arthroplasty
Lema Abuoqab1, Samuel W Rice2, David A Crawford3
1University of Massachusetts Chan Medical School, Worcester, Massachusetts.
Background:
The direct anterior approach (DAA) for total hip arthroplasty has been increasingly adopted for its muscle-sparing nature. However, wound complications remain a well-documented limitation in DAA cohorts. We evaluated the efficacy of absorbable staple augmentation as an alternative to conventional barbed sutures for incision closure in DAA total hip arthroplasty. We hypothesized that absorbable staple augmentation would be associated with reduced incidence of wound complications, particularly in patients who have elevated body mass index (BMI).
Methods:
A retrospective review was performed on 703 consecutive primary DAA cases conducted by a single surgeon. Patients were divided into two groups: absorbable intradermal staples (n = 357) and barbed sutures (n = 346). Demographics, wound complications, and return to the operating room for wound issues were recorded. Statistical analyses included unpaired t-tests for continuous variables and Chi-square or Fisher's exact tests for categorical variables. Baseline demographics were similar, though the stapler group was significantly older (P < 0.001) and had a higher BMI (P < 0.002).
Results:
The stapler group demonstrated a significantly lower wound complication rate (2.8 versus 8.1%, P < 0.002). Rates of return to the operating room for wound complications were not significantly different between groups. Across both groups, patients who had wound complications had higher BMIs (control: 38.2 versus 31.8, P < 0.001; stapler: 40.4 versus 31.0, P < 0.001). Patients who had complications tended to be younger, with no difference in sex.
Conclusions:
Absorbable staple augmentation was associated with significantly fewer complications compared to barbed sutures alone, though obese patients remained at higher risk. Potential mechanisms for improved outcomes may include its longer time to dissolve, precise edge apposition, and clearance of the epidermis, contributing to uniform tension distribution and robust wound healing. Absorbable staple augmentation may provide a practical closure method for prospective studies.