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Archives of Orthopaedic and Trauma Surgery

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30-09-2021 | Joint Infection | Hip Arthroplasty

Periprosthetic joint infection rates across primary total hip arthroplasty surgical approaches: a systematic review and meta-analysis of 653,633 procedures

Authors: Alexander J. Acuña, Michael T. Do, Linsen T. Samuel, Daniel Grits, Jesse E. Otero, Atul F. Kamath

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 10/2022

Abstract

Introduction

Evidence demonstrates comparable clinical outcomes across the various surgical approaches to primary total hip arthroplasty (THA). However, high-quality contemporary data regarding periprosthetic joint infection (PJI) risk between direct anterior approach (DAA) and other (THA) approaches is lacking. This systematic review and meta-analysis evaluated PJI rates reported in the literature between the DAA and other approaches.

Materials and methods

Five online databases were queried for all studies published from January 1st, 2000 through February 17th, 2021 that reported PJI rates between DAA and other surgical approaches. Studies reporting on primary THAs for osteoarthritis (OA) and that included PJI rates segregated by surgical approach were included. Articles reporting on revision THA, alternative THA etiologies, or minimally invasive techniques were excluded. Mantel–Haenszel (M–H) models were utilized to evaluate the pooled effect of surgical approach on infection rates. Validated risk of bias and methodological quality assessment tools were applied to each study. Multiple sensitivity analyses were conducted to evaluate the robustness of analyses.

Results

28 articles reporting on 653,633 primary THAs were included. No differences were found between DAA cohorts and combined other approaches (OR: 0.95; 95% CI 0.74–1.21; p = 0.67) as well as segregated anterolateral approach cohorts (OR: 0.82, 95% CI 0.64–1.06; p = 0.13). However, DAA patients had a significantly reduced risk of infection compared to those undergoing posterior (OR: 0.66, 95% CI 0.58–0.74; p < 0.0001) and direct lateral (OR: 0.56, 95% CI 0.48–0.65; p < 0.00001) approaches.

Conclusion

The DAA to primary THA had comparable or lower PJI risk when compared to other contemporary approaches. The results of the most up-to-date evidence available serve to encourage adult reconstruction surgeons who have already adopted the DAA. Additionally, orthopaedic surgeons considering adoption or use of the direct anterior approach for other reasons should not be dissuaded over theoretical concern for a general increase in the risk of PJI.

Level of Evidence

Level III.

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Title: Periprosthetic joint infection rates across primary total hip arthroplasty surgical approaches: a systematic review and meta-analysis of 653,633 procedures
Authors: Alexander J. Acuña
Michael T. Do
Linsen T. Samuel
Daniel Grits
Jesse E. Otero
Atul F. Kamath
Publication date: 30-09-2021
Publisher: Springer Berlin Heidelberg
Keywords: Joint Infection
Hip-TEP
Hip-TEP
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 10/2022
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-021-04186-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Periprosthetic joint infection rates across primary total hip arthroplasty surgical approaches: a systematic review and meta-analysis of 653,633 procedures

Abstract

Introduction

Materials and methods

Results

Conclusion

Level of Evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusion

Level of Evidence

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