Is Direct Anterior Approach a Credible Option for Severely Obese Patients Undergoing Total Hip Arthroplasty? A Matched-Control, Retrospective, Clinical Study

J Arthroplasty. 2018 Aug;33(8):2535-2540. doi: 10.1016/j.arth.2018.03.071. Epub 2018 Apr 11.


Background: Severely obese patients present a significant challenge for arthroplasty surgeons because of their body habitus. Up to date, there is no clear consensus on the safety of the direct anterior approach (DAA) in obese patients undergoing total hip arthroplasty. Therefore, the purpose of the present study was to determine whether DAA is a credible option in severely obese regarding complication rates, clinical outcomes, and component positioning.

Methods: Obese patients with a body mass index ≥ 35 kg/m2 (n = 129) who received total hip arthroplasty with DAA in our institution were matched for gender and age with nonobese patients with body mass index ≤ 25 kg/m2 (n = 125). The postoperative complications and clinical and radiologic outcomes were assessed retrospectively.

Results: The results of this study showed an increased risk of reoperation (relative risk: 4.0), mostly due to wound infection and dehiscence, in obese than in nonobese patients. The mean Harris Hip Score increased from 50 and 42 preoperative to 95 and 97 at the 1-year follow-up in obese patients and nonobese patients, respectively. No significant difference was observed regarding the acetabular anteversion, inclination or leg-length discrepancy, and vertical center of rotation. The horizontal center of rotation was slightly medialized (4 mm) in the nonobese compared with the obese patients (1 mm).

Conclusion: Obese patients had a higher complication and reoperation rate compared with nonobese patients. However, these rates were comparable to the rates of the standard, more extensive approaches presented in the literature. The current data suggest that DAA might be a credible option for obese patients, with excellent functional and radiographic outcomes.

Keywords: clinical outcomes; complications; direct anterior approach (DAA); obesity; total hip arthroplasty (THA).

Publication types

  • Clinical Study

MeSH terms

  • Acetabulum / diagnostic imaging
  • Acetabulum / surgery
  • Aged
  • Aged, 80 and over
  • Arthroplasty, Replacement, Hip / adverse effects*
  • Arthroplasty, Replacement, Hip / methods
  • Arthroplasty, Replacement, Hip / statistics & numerical data
  • Body Mass Index
  • Humans
  • Intraoperative Complications / etiology*
  • Leg Length Inequality / etiology
  • Middle Aged
  • Minimally Invasive Surgical Procedures
  • Obesity / complications*
  • Patient Positioning
  • Postoperative Complications / etiology*
  • Radiography
  • Recovery of Function
  • Reoperation / statistics & numerical data
  • Retrospective Studies