Risk factors for wound complications in direct anterior total hip arthroplasty: a 10-year analysis.

BACKGROUND: The purpose of this study was to identify risk factors associated with wound complications following DAA THA and to evaluate the incidence of these wound issues when negative pressure wound therapy (NPWT) was used as the primary surgical dressing.

METHODS: We reviewed 725 patients from five different surgeons at a single institution who underwent THA through a DAA from 2011 to 2023. Medical records were reviewed for demographics, comorbidities, surgical details, and a broad set of criteria denoting wound complications or dehiscence. Univariate and multivariate analyses were performed to identify potential risk factors. Secondary outcomes included periprosthetic joint infection (PJI), 90-day emergency room visits, readmission, and all-cause revision rates.

RESULTS: 83 (11.4%) patients developed a wound complication based on criteria. Univariate analysis showed that increased body mass index (BMI) (mean 30.4 vs. 27.8, p < 0.001), surgical time (138.0 vs. 108.5 minutes, p < 0.001), hospital length of stay (50.4 vs. 40.6 hours, p = 0.013), DAA surgeon experience of less than 1 year (p = 0.012) and use of NPWT (25.3 vs. 11.6%, p < 0.001) were associated with wound complications. Multivariate analysis further demonstrated BMI (OR 1.06 [1.01-1.11] p = 0.016), longer surgical time (OR 1.01 [1.00-1.01] p = 0.004), and NPWT use (OR 2.1 [1.2-3.9], p = 0.016) as associated with higher rates of wound complications. Patients with wound complications had higher rates of 90-day emergency room visits (10.8 vs. 4.4%, p = 0.018), readmissions (15.7 vs. 3.9%, p < 0.001), all-cause revision (19.3 vs. 2.8%, p < 0.001) and PJIs (13.3 vs. 0.5%, p = 0.005).

CONCLUSIONS: Obesity, length-of-stay, longer surgical time, and surgeon DAA experience <1 year were identified as risk factors for wound complications following DAA THA in our series. Prophylactic use of NPWT was not associated with a lower risk of wound complications in our cohort. Patients with wound complications had higher rates of PJI, readmission, and reoperation.