JAAOS - 2026-06-01 - Journal Article
Systematic Review of Wound Complications After Direct Anterior Approach Total Hip Arthroplasty: Incidence, Risk Factors, and Management Strategies.
Subramanian T, Oles A, Halayqeh S, Mazzucco M, Jolissaint J, Mallett K, Debbi EM, Gausden EB
Topics
Key Takeaway
Transverse (bikini) incisions reduce wound complication risk by 55% compared to longitudinal incisions in DAA THA (RR 0.45, 95% CI 0.23–0.89) across 35,300 cases.
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Summary
This systematic review characterized wound complication incidence, risk factors, and management strategies following primary DAA THA across 36 studies and 35,300 hips. The most frequent complications were superficial dehiscence/drainage (1.41%), superficial SSI (1.34%), delayed healing (1.15%), and hematoma/seroma (0.80%), with obesity and female sex as the dominant risk factors. Meta-analysis demonstrated transverse incisions conferred significantly lower wound complication risk than longitudinal incisions (RR 0.45, P=0.022), and most complications resolved with conservative local wound care.
Key Limitation
Inconsistent wound complication definitions across the 36 included studies introduce significant heterogeneity that undermines the reliability of pooled incidence figures.
Original Abstract
BACKGROUND
Wound complications after direct anterior approach (DAA) total hip arthroplasty (THA) are an important source of postoperative morbidity. Although several risk factors and management strategies have been proposed, data remain heterogeneous. This systematic review aims to characterize the incidence, risk factors, and management of wound complications after DAA THA.
METHODS
A systematic review was done across eight databases (PubMed, Embase, Scopus, Cochrane Library, CINAHL, Web of Science, Ovid MEDLINE, and ClinicalKey) according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Studies were included if they reported wound complications after primary DAA THA. Data were extracted on complication incidence, risk factors, closure and dressing techniques, and management strategies. A meta-analysis comparing wound complication rates between transverse (bikini) and longitudinal incisions was done using a common-effects model.
RESULTS
Thirty-six studies encompassing 35,300 DAA THA were included. The most common wound complications were superficial dehiscence/drainage (1.41%), superficial surgical site infection (1.34%), delayed wound healing (1.15%), and hematoma/seroma (0.80%). Obesity and female sex were the most frequently identified risk factors. Pooled analysis demonstrated that transverse (bikini) incisions were associated with a significantly lower risk of wound complications compared with longitudinal incisions (relative risk 0.45, 95% confidence interval, 0.23 to 0.89; P = 0.0219). Closure technique and dressing choice showed variable influence on complication rates. Most wound complications were successfully managed with local wound care, avoiding the need for revision surgery.
CONCLUSION
Wound complications after DAA THA are relatively uncommon and often manageable with conservative measures. Obesity, female sex, and longitudinal incisions are associated with higher complication risk. Surgical technique, including consideration of incision type and appropriate postoperative wound management, may help minimize complications.