Early Outcomes of Obese Patients Undergoing Total Hip Arthroplasty: Comparison of Anterior to Posterior Approach

BACKGROUND: There has been an increase in total hip arthroplasty in obese patients and surgical complication rates are known to be higher in this population. This retrospective study evaluated complication rates for obese patients undergoing total hip replacement compared to non-obese patients. Additionally, we compared complication rates for direct anterior approach (ATHA) versus posterior approach (PTHA). METHODS: This study was an IRB approved retrospective review of 210 patients undergoing ATHA and 201 patients undergoing PTHA during the same time period by 2 total joint surgeons. Non-obese patients were compared to obese patients using body mass index (BMI) classification. Minor and major complications were reviewed as well as length of stay, disposition, and other short-term outcome measures. RESULTS: The non-obese cohort (BMI < 30) had lower complication rates (2.8% major, 4.4% minor) compared to the obese cohort (8.7% major, 9.9% minor). Major complications by obese class were: Class I 8.6%, Class II 7.1% and Class III 11.5%. The non-obese ATHA cohort had lower complication rates (0.8% major, 5.0% minor) compared to the PTHA cohort (5.0% major, 6.7% minor). Obese patients had 6.3% major and 9.9% minor complication rates in ATHA, compared to 11.1% major and 10.0% minor complication rates in PTHA. Lastly, the evaluation of short-term outcomes showed more favorable results for ATHA for both obese and non-obese patients. CONCLUSION: Obesity was associated with an increased risk of complications and less favorable short-term outcomes following THA. Direct anterior THA was associated with lower complication rates and more favorable short-term outcomes.