Direct Anterior Approach Has Lower Deep Infection Frequency Than Less Invasive Direct Lateral Approach in Primary Total Hip Arthroplasty


Debate continues over the direct anterior (DA) approach. The purpose of this study is to compare the frequency of deep infection between a DA approach and a less invasive direct lateral (LIDL) approach in a large consecutive series of primary total hip arthroplasty (THA). The authors identified 5702 primary THAs performed between 2007 and 2014. DA approach was used in 3540 hips and LIDL in 2162. Patient records were reviewed. Statistical analysis of reoperation, infection- or wound-related complication, and deep infection was performed. During the 8-year follow-up period, there were 98 reoperations in the DA group (2.8%) and 77 in the LIDL group (3.6%; p D .09 NS). Wound- or infection-related reoperation occurred in 32 DA THAs (0.9%) versus 36 LIDL THAs (1.7%; p D .01). Deep infection occurred in 7 DA THAs (0.2%) versus 21 LIDL THAs (0.97%; p < .0001). The risk of deep infection was statistically lower in the DA approach. (Journal of Surgical Orthopaedic Advances 27(1):21–24, 2018) Key words: direct anterior approach, infection, surgical technique, total hip arthroplasty

Sean A. Sutphen, DO; Keith R. Berend, MD; Michael J. Morris, MD; and Adolph V. Lombardi, Jr., MD, FACS