23 Mar Complication Rates Vary Between Hip Surgery Approaches
MedicalResearch.com Interview with:
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.
- 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
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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