Comparison of Wound Complications Between Two Closing Techniques Following Total Hip Arthroplasty Via the Direct Anterior Approach

Abstract

A higher rate of wound complications has been reported in the direct anterior approach (DAA) for total hip arthroplasty (THA), reportedly due to the location of the incision and poor surgical site exposure techniques. Therefore, the purpose of this study was to compare wound complications within the first 90 days between a zipper closing method (ZM) and subcuticular monocryl with dermabond skin closure (SMD). A total of 294 patients (352 hips) were closed using the SMD and 166 patients (206 hips) were closed via the ZM. All THAs via the DAA and postoperative care were performed based on the current standard of care for the treatment of symptomatic hip osteoarthritis, established by a single, high volume surgeon from 2016 to 2018. Any wound complications during the first 90 days were noted. Independent t-tests determined differences in descriptive variables. Additionally, a Fisher Exact test was performed to compare wound complication rate between groups (p < 0.05). Surgical time was significantly shorter for ZM (p < 0.001) for both unilateral and bilateral groups compared with SMD. Overall, there were four complications occurring in 558 cases (0.7%), with two cases (0.36%) requiring additional surgery. No wound complications were present in the SMD and four wound complications (1.9%), two requiring surgery, were reported for the ZM (χ2 [1, N = 558] = 6.884, p = 0.009). While no wound complications were reported in the SMD group, the ZM group sustained four wound complications, two of which required additional surgery. Two of these wound complications occurred within the first 14 cases following implementation of the ZM, perhaps indicating a short learning curve. The ZM is a quicker, perhaps easier closure method yet the added expense for materials and suggested increased risk for wound complications may moderate the enthusiasm of the ZM compared with the sutures following THA via the DAA.

Keywords

direct anterior approach - total hip arthroplasty - wound closure - Zipper method - sutures

• References

• 1 Matta JM, Shahrdar C, Ferguson T. Single-incision anterior approach for total hip arthroplasty on an orthopaedic table. Clin Orthop Relat Res 2005; 441 (441) 115-124
• 2 Christensen CP, Karthikeyan T, Jacobs CA. Greater prevalence of wound complications requiring reoperation with direct anterior approach total hip arthroplasty. J Arthroplasty 2014; 29 (09) 1839-1841
• 3 Purcell RL, Parks NL, Cody JP, Hamilton WG. Comparison of wound complications and deep infections with direct anterior and posterior approaches in obese hip arthroplasty patients. J Arthroplasty 2018; 33 (01) 220-223
• 4 Jewett BA, Collis DK. High complication rate with anterior total hip arthroplasties on a fracture table. Clin Orthop Relat Res 2011; 469 (02) 503-507
• 5 Purcell RL, Parks NL, Gargiulo JM, Hamilton WG. Severely obese patients have a higher risk of infection after direct anterior approach total hip arthroplasty. J Arthroplasty 2016; 31 (9, Suppl): 162-165
• 6 Russo MW, Macdonell JR, Paulus MC, Keller JM, Zawadsky MW. Increased complications in obese patients undergoing direct anterior total hip arthroplasty. J Arthroplasty 2015; 30 (08) 1384-1387
• 7 Khan RJ, Fick D, Yao F. , et al. A comparison of three methods of wound closure following arthroplasty: a prospective, randomised, controlled trial. J Bone Joint Surg Br 2006; 88 (02) 238-242
• 8 Rui M, Zheng X, Sun SS. , et al. A prospective randomised comparison of 2 skin closure techniques in primary total hip arthroplasty surgery. Hip Int 2018; 28 (01) 101-105
• 9 Livesey C, Wylde V, Descamps S. , et al. Skin closure after total hip replacement: a randomised controlled trial of skin adhesive versus surgical staples. J Bone Joint Surg Br 2009; 91 (06) 725-729
• 10 Glennie RA, Korczak A, Naudie DD, Bryant DM, Howard JL. MONOCRYL and DERMABOND vs staples in total hip arthroplasty performed through a lateral skin incision: a randomized controlled trial using a patient-centered assessment tool. J Arthroplasty 2017; 32 (08) 2431-2435
• 11 Fisher DA, Bengero LL, Clapp BC, Burgess M. A randomized, prospective study of total hip wound closure with resorbable subcuticular staples. Orthopedics 2010; 33 (09) 665
• 12 Carli AV, Spiro S, Barlow BT, Haas SB. Using a non-invasive secure skin closure following total knee arthroplasty leads to fewer wound complications and no patient home care visits compared to surgical staples. Knee 2017; 24 (05) 1221-1226
• 13 Kennon RE, Keggi JM, Wetmore RS, Zatorski LE, Huo MH, Keggi KJ. Total hip arthroplasty through a minimally invasive anterior surgical approach. J Bone Joint Surg Am 2003; 85-A (Suppl. 04) 39-48
• 14 Sutphen SA, Berend KR, Morris MJ, Lombardi Jr AV. Direct anterior approach has lower deep infection frequency than less invasive direct lateral approach in primary total hip arthroplasty. J Surg Orthop Adv 2018; 27 (01) 21-24