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Total Hip Arthroplasty Using Direct Anterior Approach in Obese Patients: A Systematic Review and Meta-analysis
Andrzej Bałoniak1, Tomasz Markiewicz1, Waldemar Woźniak1
1Department of General Orthopaedics, Musculoskeletal Oncology and Trauma Surgery, Poznan University of Medical Sciences, Ul. 28 Czerwca 1956 R 135/147, 60-545 Poznań, Poland.
Purpose:
Obesity is a major global health concern, and a significant number of patients undergo total hip arthroplasty (THA). The direct anterior approach (DAA) is one of the most used minimally invasive surgical techniques for THA worldwide. However, no study has quantitatively synthesized the outcomes of obese patients treated with this approach.
Methods:
We searched the PubMed, Embase, and Cochrane Library databases. Outcomes (complications, revision rates, cup inclination/anteversion, leg-length discrepancy, operative time, length of stay, and functional outcomes) were pooled using random-effects models. Risk of bias was assessed using the Newcastle-Ottawa Scale/Risk of Bias 2 tool.
Results:
Seventeen studies (one prospective and sixteen retrospective) comprising 16,258 patients and 16,889 hips were included in the analysis. Obesity was associated with higher periprosthetic joint infection rates (0.9 vs. 0.24%), (P < .001; RR, 4.23; 95% CI 2.32-7.72; I 2 = 0%), wound complications (3.72 vs. 1.03%), (P < .001; RR, 3.12; 95% CI 1.92-5.06; I 2 = 20.6%), and revision rates (2.96 vs. 1.19%), (P = .008; RR, 2.42; 95% CI 1.35-4.34; I 2 = 33.0%). No statistically or clinically significant differences were observed in dislocation, fracture, leg-length discrepancy, cup anteversion, or length of hospital stay.
Conclusion:
Current evidence indicates that DAA is a viable option for obese patients with generally low complication rates. However, obesity is associated with an increased risk of periprosthetic joint infections, wound complications, and revision rates.
Prospero Registration Number:
CRD420251031606.
Supplementary Information:
The online version contains supplementary material available at https://doi.org/10.1007/s43465-026-01838-7.
