Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Archives of Orthopaedic and Trauma Surgery
Published in: Archives of Orthopaedic and Trauma Surgery 10/2022

12-09-2021 | Obesity | Hip Arthroplasty

Bikini anterior hip replacements in obese patients are not associated with an increased risk of complication

Authors: I. Nizam, D. Dabirrahmani, A. Alva, D. Choudary

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

Login to get access

Abstract

Purpose

Direct anterior approach (DAA) arthroplasty has generated great interest because of its minimally invasive and muscle sparing nature. Obese patients are reported to be associated with greater incidence of complications in primary joint replacement. The purpose of this study was to compare patient outcomes and complication rates between obese and non-obese patients undergoing primary total hip arthroplasty (THA) through a Bikini direct anterior incision.

Methods

This retrospective, single surgeon study compared the outcome of 258 obese patients and 200 non-obese patients undergoing DAA THA using a Bikini incision, over a 5-year period. The average follow-up was 3.2 years (range 1.1–5.6 years).

Results

There was no statistically significant differences in the complication rate between the two groups. The obese group recorded 2 major (venous thromboembolism and peri-prosthetic fracture) and 2 minor complications (superficial wound infection), compared with the non-obese group, which recorded 2 major (deep-wound infection and peri-prosthetic fracture) and 1 minor complication (superficial wound infection). Patient-reported outcomes (WOMAC and Harris Hip Scores) showed significant post-operative improvements (p < 0.001) and did not differ between the two groups.

Conclusions

Bikini DDA THA does not increase the complication rate in obese patients and offers similar clinical improvements compared to non-obese patients.
Literature
1.
(2000) Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser, 894:i-xii, 1–253
2.
Adhikary SD, Liu WM, Memtsoudis SG, Davis CM 3rd, Liu J (2016) Body mass index more than 45 kg/m(2) as a cutoff point is associated with dramatically increased postoperative complications in total knee arthroplasty and total hip arthroplasty. J Arthroplasty 31(4):749–753PubMedCrossRef
3.
Aggarwal VK, Elbuluk A, Dundon J, et al. (2019) Surgical approach significantly affects the complication rates associated with total hip arthroplasty. Bone Joint J., 101-B(6):646–651. 610.1302/0301-1620X.1101B1306.BJJ-2018-1474.R1301.
4.
Alecci V, Valente M, Crucil M, Minerva M, Pellegrino CM, Sabbadini DD (2011) Comparison of primary total hip replacements performed with a direct anterior approach versus the standard lateral approach: perioperative findings. J Orthop Traumatol 12(3):123–129PubMedPubMedCentralCrossRef
5.
Barrett WP, Turner SE, Leopold JP (2013) Prospective randomized study of direct anterior vs postero-lateral approach for total hip arthroplasty. J Arthroplasty 28(9):1634–1638PubMedCrossRef
6.
Berndt K, Rahm S, Dora C, Zingg PO (2019) Total hip arthroplasty with accolade/trident through the direct minimally invasive anterior approach without traction table: learning curve and results after a minimum of 5 years. Orthop Traumatol Surg Res 105(5):931–936PubMedCrossRef
7.
Bookman JS, Schwarzkopf R, Rathod P, Iorio R, Deshmukh AJ (2018) Obesity: the modifiable risk factor in total joint arthroplasty. Orthop Clin North Am 49(3):291–296PubMedCrossRef
8.
Bourne R, Mukhi S, Zhu N, Keresteci M, Marin M (2007) Role of obesity on the risk for total hip or knee arthroplasty. Clin Orthop Relat Res 465:185–188PubMedCrossRef
9.
Christensen CP, Jacobs CA (2015) Comparison of patient function during the first 6 weeks after direct anterior or posterior total hip arthroplasty (THA): a randomized study. J Arthroplasty 30(9 Suppl):94–97PubMedCrossRef
10.
Christensen CP, Karthikeyan T, Jacobs CA (2014) Greater prevalence of wound complications requiring reoperation with direct anterior approach total hip arthroplasty. J Arthroplasty 29(9):1839–1841PubMedCrossRef
11.
WotAAoHaKSEB C (2013) Obesity and total joint arthroplasty: a literature based review. J Arthroplasty 28(5):714–721CrossRef
12.
13.
Davis AM, Wood AM, Keenan AC, Brenkel IJ, Ballantyne JA (2011) Does body mass index affect clinical outcome post-operatively and at five years after primary unilateral total hip replacement performed for osteoarthritis? A multivariate analysis of prospective data. J Bone Joint Surg Br 93(9):1178–1182PubMedCrossRef
14.
Ethgen O, Bruyere O, Richy F, Dardennes C, Reginster JY (2004) Health-related quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature. J Bone Joint Surg Am, 86(5):963–974
15.
Felson DT, Niu J, Clancy M, Sack B, Aliabadi P, Zhang Y (2007) Effect of recreational physical activities on the development of knee osteoarthritis in older adults of different weights: the framingham study. Arthritis Rheum 57(1):6–12PubMedCrossRef
16.
Galea VP, Rojanasopondist P, Ingelsrud LH, et al. (2019) Longitudinal changes in patient-reported outcome measures following total hip arthroplasty and predictors of deterioration during follow-up: a seven-year prospective international multicentre study. Bone Joint J, 101-B(7):768–778
17.
Haverkamp D, Klinkenbijl MN, Somford MP, Albers GH, van der Vis HM (2011) Obesity in total hip arthroplasty–does it really matter? A meta-analysis. Acta Orthop 82(4):417–422PubMedPubMedCentralCrossRef
18.
19.
Huffman KD, Sanford BA, Zucker-Levin AR, Williams JL, Mihalko WM (2015) Increased hip abduction in high body mass index subjects during sit-to-stand. Gait Posture 41(2):640–645PubMedCrossRef
20.
21.
Jewett BA, Collis DK (2011) High complication rate with anterior total hip arthroplasties on a fracture table. Clin Orthop Relat Res 469(2):503–507PubMedCrossRef
22.
Kennon RE, Keggi JM, Wetmore RS, Zatorski LE, Huo MH, Keggi KJ (2003) Total hip arthroplasty through a minimally invasive anterior surgical approach. J Bone Joint Surg Am, 85-A Suppl 4:39–48
23.
Kerr DR, Kohan L (2008) Local infiltration analgesia: a technique for the control of acute postoperative pain following knee and hip surgery: a case study of 325 patients. Acta Orthop 79(2):174–183PubMedCrossRef
24.
Leunig M, Faas M, von Knoch F, Naal FD (2013) Skin crease “bikini” incision for anterior approach total hip arthroplasty: surgical technique and preliminary results. Clin Orthop Relat Res 471(7):2245–2252PubMedPubMedCentralCrossRef
25.
Leunig M, Hutmacher JE, Ricciardi BF, Impellizzeri FM, Rudiger HA, Naal FD (2018) Skin crease 'bikini' incision for the direct anterior approach in total hip arthroplasty: a two- to four-year comparative study in 964 patients. Bone Joint J, 100-B(7):853–861
26.
Lewinnek GE, Lewis JL, Tarr R, Compere CL, Zimmerman JR (1978) Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg Am 60(2):217–220PubMedCrossRef
27.
Li S, Luo X, Sun H, Wang K, Zhang K, Sun X (2019) Does prior bariatric surgery improve outcomes following total joint arthroplasty in the morbidly obese? A Meta-Analysis. J Arthroplasty 34(3):577–585PubMedCrossRef
28.
Malinzak RA, Ritter MA, Berend ME, Meding JB, Olberding EM, Davis KE (2009) Morbidly obese, diabetic, younger, and unilateral joint arthroplasty patients have elevated total joint arthroplasty infection rates. J Arthroplasty 24(6 Suppl):84–88PubMedCrossRef
29.
Manrique J, Paskey T, Tarabichi M, Restrepo C, Foltz C, Hozack WJ (2019) Total hip arthroplasty through the direct anterior approach using a bikini incision can be safely performed in obese patients. J Arthroplasty 34(8):1723–1730PubMedCrossRef
30.
Morton JM, Rosenthal RJ (2019) Bariatric surgery: safety, efficacy, disease state, collaboration. Future J Arthroplasty 34(7S):S36–S37PubMedCrossRef
31.
Mouchti S, Whitehouse MR, Sayers A, Hunt LP, MacGregor A, Blom AW (2018) The association of body mass index with risk of long-term revision and 90-day mortality following primary total hip replacement: findings from the national joint registry for England, Wales, Northern Ireland and the Isle of Man. J Bone Joint Surg Am 100(24):2140–2152PubMedCrossRef
32.
Nakata K, Nishikawa M, Yamamoto K, Hirota S, Yoshikawa H (2009) A clinical comparative study of the direct anterior with mini-posterior approach: two consecutive series. J Arthroplasty 24(5):698–704PubMedCrossRef
33.
Nizam I (2015) The Bikini Hip Replacement- Surgical Technique Preserving Vessels and Deep Soft Tissues in Direct Anterior Approach Hip Replacement. HSOA J Orthopedic Res Physiotherapy, 1(007)
34.
Organization WH (2019) Global Strategy on Diet, Physical Activity and Health(ed)^(eds). World Health Organisation,
35.
Poehling-Monaghan KL, Kamath AF, Taunton MJ, Pagnano MW (2015) Direct anterior versus miniposterior THA with the same advanced perioperative protocols: surprising early clinical results. Clin Orthop Relat Res 473(2):623–631PubMedCrossRef
36.
Post ZD, Orozco F, Diaz-Ledezma C, Hozack WJ, Ong A (2014) Direct anterior approach for total hip arthroplasty: indications, technique, and results. J Am Acad Orthop Surg 22(9):595–603PubMedCrossRef
37.
Purcell RL, Parks NL, Gargiulo JM, Hamilton WG (2016) Severely obese patients have a higher risk of infection after direct anterior approach total hip arthroplasty. J Arthroplasty 31(9 Suppl):162–165PubMedCrossRef
38.
Rahm S, Tondelli T, Steinmetz S, Schenk P, Dora C, Zingg PO (2019) Uncemented total hip arthroplasty through the direct anterior approach: analysis of a consecutive series of 275 hips with a minimum follow-up of 10 years. J Arthroplasty 34(6):1132–1138PubMedCrossRef
39.
Roth A, Khlopas A, George J et al (2019) The effect of body mass index on 30-day complications after revision total hip and knee arthroplasty. J Arthroplasty 34(7S):S242–S248PubMedCrossRef
40.
Russo MW, Macdonell JR, Paulus MC, Keller JM, Zawadsky MW (2015) Increased complications in obese patients undergoing direct anterior total hip arthroplasty. J Arthroplasty 30(8):1384–1387PubMedCrossRef
41.
Schwarzkopf R, Thompson SL, Adwar SJ, Liublinska V, Slover JD (2012) Postoperative complication rates in the “super-obese” hip and knee arthroplasty population. J Arthroplasty 27(3):397–401PubMedCrossRef
42.
Scully W, Piuzzi NS, Sodhi N, et al. (2019) The effect of body mass index on 30-day complications after total hip arthroplasty. Hip Int:1120700019826482
43.
Skytta ET, Jarkko L, Antti E, Huhtala H, Ville R (2011) Increasing incidence of hip arthroplasty for primary osteoarthritis in 30- to 59-year-old patients. Acta Orthop 82(1):1–5PubMedPubMedCentralCrossRef
44.
Sloan M, Sheth N, Lee GC (2019) Is obesity associated with increased risk of deep vein thrombosis or pulmonary embolism after hip and knee arthroplasty? a large database study. Clin Orthop Relat Res 477(3):523–532PubMedPubMedCentralCrossRef
45.
Springer BD (2019) Management of the bariatric patient. What are the implications of obesity and total joint arthroplasty: the orthopedic surgeon's perspective? J Arthroplasty, 34(7S):S30-S32
46.
Taunton MJ, Mason JB, Odum SM, Springer BD (2014) Direct anterior total hip arthroplasty yields more rapid voluntary cessation of all walking aids: a prospective, randomized clinical trial. J Arthroplasty 29(9 Suppl):169–172PubMedCrossRef
47.
Tsukada S, Wakui M (2015) Lower dislocation rate following total hip arthroplasty via direct anterior approach than via posterior approach: five-year-average follow-up results. Open Orthop J 9:157–162PubMedPubMedCentralCrossRef
48.
Watts CD, Houdek MT, Wagner ER, Sculco PK, Chalmers BP, Taunton MJ (2015) High risk of wound complications following direct anterior total hip arthroplasty in obese patients. J Arthroplasty 30(12):2296–2298PubMedCrossRef
49.
Zawadsky MW, Paulus MC, Murray PJ, Johansen MA (2014) Early outcome comparison between the direct anterior approach and the mini-incision posterior approach for primary total hip arthroplasty: 150 consecutive cases. J Arthroplasty 29(6):1256–1260PubMedCrossRef
Metadata
Title
Bikini anterior hip replacements in obese patients are not associated with an increased risk of complication
Authors
I. Nizam
D. Dabirrahmani
A. Alva
D. Choudary
Publication date
12-09-2021
Publisher
Springer Berlin Heidelberg
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/s00402-021-04143-0

Other articles of this Issue 10/2022

Archives of Orthopaedic and Trauma Surgery 10/2022 Go to the issue

Orthopaedic Surgery

The application of an allogeneic bone screw for osteosynthesis in hand and foot surgery: a case series

Hip Arthroplasty

Single-stage total hip arthroplasty after failed fixation of proximal femoral fractures: an increased risk for periprosthetic joint infections?

Orthopaedic Surgery

Patient compliance with hip precautions 12 weeks following primary elective total hip arthroplasty

Arthroscopy and Sports Medicine

Multiple platelet-rich plasma injections are superior to single PRP injections or saline in osteoarthritis of the knee: the 2-year results of a randomized, double-blind, placebo-controlled clinical trial

Hip Arthroplasty

Hydroxyapatite-coated compaction short stem represents a characteristic pattern of peri-prosthetic bone remodelling after total hip arthroplasty

Orthopaedic Surgery

Effectiveness and safety of percutaneous kyphoplasty combined with zoledronic acid in treatment of osteoporotic vertebral compression fractures: a meta-analysis