Daniel Pincus MD PhD Division of Orthopaedic Surgery, Department of Surgery, University of Toronto Sunnybrook Health Sciences Centre, Division of Orthopaedic Surgery,  ICES, Toronto, Ontario, Canada

Complication Rates Vary Between Hip Surgery Approaches

MedicalResearch.com Interview with:

Daniel Pincus MD PhD Division of Orthopaedic Surgery, Department of Surgery, University of Toronto Sunnybrook Health Sciences Centre, Division of Orthopaedic Surgery,  ICES, Toronto, Ontario, Canada

Dr. Pincus

Pincus MD PhD
Division of Orthopaedic Surgery, Department of Surgery
University of Toronto
Sunnybrook Health Sciences Centre, Division of Orthopaedic Surgery
ICES, Toronto, Ontario, Canada

MedicalResearch.com: What is the background for this study?

Response: Controversy exists among arthroplasty surgeons and patients about the best surgical approach for total hip arthroplasty (THA) – one of the most common operations performed worldwide. In the last few years, the direct anterior approach has become increasingly popular compared to posterior and lateral approaches, partially as a result of advertising to patients.  We sought to determine whether a direct anterior surgical approach was associated with lower surgical complications compared to lateral and posterior approaches.

 MedicalResearch.com: What are the main findings?

Response: Our findings suggest the opposite – a significantly increased risk of major surgical complications with the direct anterior approach. That there was still a higher risk despite the patients who received the direct anterior approach being younger, healthier and operated on by higher volume surgeons – situations where we typically expect fewer complications – adds further support that the findings are accurate. 

MedicalResearch.com: What should readers take away from your report?

Response: The direct anterior approach has a risk profile that is different from its public perception.

Complications included:

  • Three times the risk for deep infection requiring surgery, two times the risk for dislocation requiring closed or open reduction, and two times the risk for revision arthroplasty.
  • These new findings are based on current data from a large diverse population and may help inform clinical decision-making for the increasing number of patients with hip arthritis and surgeons performing THA.    

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: More research is needed to understand pain and functional outcomes, which also need to be considered in choosing a surgical approach

No disclosures 

Citation:

Pincus D, Jenkinson R, Paterson M, Leroux T, Ravi B. Association Between Surgical Approach and Major Surgical Complications in Patients Undergoing Total Hip Arthroplasty. JAMA. 2020;323(11):1070–1076. doi:10.1001/jama.2020.0785

 

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Last Modified: Mar 23, 2020 @ 6:25 pm

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