Major complications after total hip arthroplasty with the direct anterior approach at a high-volume Ontario tertiary care centre

• Published in: Canadian Journal of Surgery Vol. 66; no. 6; pp. E596 - E601
• Main Authors: Barton, Kristen I, Steiner, Nicholas J, Boldt, Kevin R, Sogbein, Olawale A, Tsioros, Stephen M, Somerville, Lyndsay, Howard, James L, Lanting, Brent A
• Format: Journal Article
• Language: English
• Published: Canada CMA Impact Inc 01.12.2023; CMA Impact, Inc
• Subjects: Abscesses; Arthritis; Arthroplasty, Replacement, Hip - adverse effects; Arthroplasty, Replacement, Hip - methods; Body mass index; Bone surgery; Cohort analysis; Complications; Erythema; Fractures; Hematoma; Hip Prosthesis - adverse effects; Hospitals; Humans; Infections; Joint replacement surgery; Learning curves; Male; Ontario - epidemiology; Orthopedics; Osteoarthritis; Patients; Periprosthetic Fractures - epidemiology; Periprosthetic Fractures - etiology; Periprosthetic Fractures - surgery; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Reoperation - adverse effects; Retrospective Studies; Surgeons; Surgery; Surgical outcomes; Tertiary Care Centers; Wound dehiscence; Wound Infection - complications; Ontario; Canada; Ontario Canada
• ISSN: 0008-428X; 1488-2310
• DOI: 10.1503/cjs.005223

The rate of major surgical complications for high-volume orthopedic surgeons using the direct anterior approach (DAA) in Ontario, Canada, is not known. The purpose of this study was to investigate the rate of major surgical complications after total hip arthroplasty (THA) using DAA performed by experienced orthopedic surgeons at a high-volume tertiary care centre in Ontario. We conducted a retrospective cohort review of primary THA through DAA performed by 2 experienced fellowship-trained surgeons at an academic hospital in London, Ontario, between Jan. 1, 2012, and May 1, 2019. We excluded the first 100 cases to allow for surgeon learning curves. We recorded major surgical complications (intraoperative events, postoperative periprosthetic fractures, dislocation requiring closed or open reduction, implant failure [aseptic loosening or subsidence], early (< 6 wk) deep wound infection requiring irrigation and débridement, late (≥ 6 wk) deep wound infection requiring irrigation and débridement, and wound complications [wound dehiscence, stitch abscess, erythema, hematoma or seroma]) within 1 year of THA. A total of 875 primary DAA THA procedures were included. The rates of surgical complications were 0.9% for intraoperative events, 1.5% for postoperative periprosthetic fractures, 0.8% for implant failure, 0.7% for early deep wound infection, 0.1% for late deep wound infection and 3.2% for wound complications; there were no cases of dislocation. The rate of revision for implant failure within 1 year was 0.1%. Male sex was associated with a greater risk of implant failure ( = 0.01), and having a higher body mass index was associated with both increased rates of infection ( < 0.01) and having a wound complication ( < 0.01). Intraoperative events, postoperative periprosthetic fractures, implant failure, deep wound infection and wound complications accounted for the major surgical complications within 1 year of THA through DAA. The low revision rate suggests that DAA is a safe approach for THA.