Does surgical approach for total hip arthroplasty (THA) affect survival in the obese patient? Are thresholds and considerations in surgical decision making for approach in regards to BMI changing over time? – Results of a nationwide observational registry study.
Approval date: November 25th 2025
RM Peters, J Kuiper, B van Steijnen, WP Zijlstra
Research proposal abstract
In patients with (morbid) obesity, primary THA often poses technical challenges due to extensive soft tissue, which may compromise optimal surgical exposure and component positioning, causing extended procedure time, increased blood loss, prolonged wound leakage and increased risk for postoperative complications (e.g. periprosthetic joint infection, revision surgery).
In general, the LROI has recorded a shift in the surgical approach for primary THA in the general population over the last two decades, as the use of the direct lateral, anterolateral and posterolateral approach (PLA) decreased, while the direct anterior approach (DAA) was employed more frequently.
Postoperative outcome of THA may differ depending upon surgical approach, and specific advantages and disadvantages may be present in the obese population. Some surgeons advocate the use of the PLA over DAA in (morbidly) obese patients undergoing THA, due to compromise of inguinal hygiene, which may predispose them to infections if the DAA is used, as opposed to the PLA, where the skin incision has less proximity to the inguinal crease (Argyrou 2022).
The main purpose of this register-based cohort study is to investigate if surgical approach (PLA vs DAA) is associated with risk of revision within 1-, 5- and 10- years, after primary THA for patients with obesity (separated into BMI classes). Secondly, we aim to examine if there is a detectable change in threshold for DAA THA in patients with obesity over the past decennium.