No increased PJI risk seen with use of direct anterior hip arthroplasty approach
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Direct anterior approach to total hip arthroplasty does not lead to an increased risk for periprosthetic joint infection, according to a study presented at the Musculoskeletal Infection Society Annual Meeting.
“Direct anterior (DA) arthroplasty is widely considered one of the most successful orthopedic procedures and excellent outcomes can be expected for patients, regardless of surgical approach,” Noam Shohat, MD, of Rothman Orthopaedic Institute, said. “The majority of research reports that DA approach provided favorable short-term functional outcomes and a more rapid recovery. There is continuous debate surrounding differences in complications and there is disagreement on whether a DA approach leads to an increased risk for periprosthetic joint infection (PJI).”
In a single-center retrospective study, primary total hip arthroplasty procedures were analyzed for approach (DA vs. direct lateral), patient characteristics, operative details and PJI preventative protocols. Investigators evaluated the overall associations between surgical approach and PJI and performed univariate and multivariate logistic regression analyses.
Results showed patients in the DA cohort tended to be younger and healthier compared to the direct lateral cohort. Further comparison showed PJI rates were lower in the DA cohort (0.9% vs. 1.3%) with an overall increase in PJI rates when patients had a higher BMI. No significant differences between surgical approach and type of infecting organism were found. Multivariate logistic regression showed the DA approach carried an overall odds ratio of 0.760.
“This is the largest study to date to examine the association between surgical approach and PJI,” Shohat concluded. “The key finding is that direct anterior approach does not lead to an increased risk for PJI.”
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Shohat N, et al. Presentation 25. Presented at: Musculoskeletal Infection Society Annual Meeting; Aug. 7-8, 2020 (virtual meeting).
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