Feasibility and outcomes of the direct anterior approach in total hip arthroplasty for obese patients: a systematic review.
N Corradi, A Trimarchi, A L Soldati et al.
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In 30 seconds
This systematic review assessed clinical and functional outcomes, complications, and reoperations after direct anterior approach total hip arthroplasty (DAA-THA) in obese versus non-obese patients. Eleven studies included 8,062 THAs: 3,658 in obese patients and 4,386 in non-obese patients. Both groups improved functionally, with similar Harris Hip Scores (94.38 in obese vs. 93.85 in non-obese patients). Obese patients had longer surgical times and higher complication and reoperation rates; reoperations were 1.69% vs. 0.7%.
Key findings
- Postoperative Harris Hip Scores were similar: 94.38 in obese vs. 93.85 in non-obese patients.
- Mean surgical time was longer in obese patients: 82.52 vs. 68.82 min.
- Complication rates were 5.5% in obese patients and 4.88% in non-obese patients, with more wound infections, periprosthetic joint infections, and deep vein thrombosis in the obese group.
- Reoperation rates were higher in obese patients: 1.69% vs. 0.7%.
Why it matters
The review suggests that obesity does not preclude comparable functional improvement after DAA-THA, but it is associated with greater operative burden and higher complication and reoperation rates. These findings help frame perioperative risk discussions and highlight the importance of careful assessment and follow-up, while recognising that the evidence is drawn from included studies rather than a randomised comparison.
What to keep in mind
The review calls for further high-quality studies with longer follow-up; the abstract does not report follow-up duration or provide pooled uncertainty estimates.