A study found that, for patients undergoing total hip arthroplasty (THA) via the anterior approach, abdominal pannus size did not affect the risk of delayed wound healing or reoperation within the first 90 days after surgery when compared with THA via the posterior approach.

The research was presented at the AAOS 2024 Annual Meeting by Samantha E. Bialek, MD, a second-year orthopaedic surgery resident at Loyola University Medical Center in Maywood, Illinois.

“Large abdominal pannus size is a risk factor for complications with anterior-approach THA. However, it is unclear if changing to a posterior approach mitigates this risk,” the authors of the study wrote. Therefore, they sought to “evaluate whether abdominal pannus size had a differential effect on complication rates comparing anterior versus posterior THA.”

The investigators conducted a retrospective review of 1,000 consecutive primary THA patients. Of those patients, 478 underwent THA via the anterior approach and 522 underwent THA via the posterior approach. The size of the abdominal pannus was radiographically measured on an anteroposterior pelvis image and categorized into four groups based on vertical size: no pannus, above symphysis, below symphysis, or below ischial tuberosities.

The rate of complication and/or delayed wound healing in anterior-approach patients with no pannus was 1.9 percent versus 3.9 percent in posterior-approach patients (P = 0.21). The rate of complication and/or delayed wound healing for patients with pannus above symphysis was 7.2 percent and 6.7 percent in the anterior- versus posterior-approach groups, respectively (P = 0.08). Anterior-approach patients with pannus below symphysis had a complication and/or delayed wound healing rate of 17.9 percent compared with 11.6 percent for posterior-approach patients (P = 0.27). Lastly, posterior-approach patients with pannus below ischial tuberosities experienced complications and/or delayed wound healing at a rate of 15.5 percent versus 16.7 percent of patients in the anterior-approach group (P = 0.84).

Similar trends were observed between anterior and posterior approaches in terms of reoperations for no pannus (0.9 percent versus 1.1 percent, P = 0.08), pannus above symphysis (1.4 percent versus 2 percent, P = 0.72), pannus below symphysis (3.0 percent versus 5.8 percent, P = 0.41), and pannus below ischial tuberosities (1.7 percent versus 4.5 percent, P = 0.33).

“Additionally, when controlling for BMI, age, race, gender, Charlson Comorbidity Index, and smoking in the logistic regression models, there was no statistically significant difference in the odds of wound complications or return to the OR between the approaches at each pannus size,” the authors reported.

The findings of this study suggest that in primary anterior THA patients, the presence of an abdominal pannus of any size does not independently increase the risk of complications, delayed wound healing, or reoperation within 90 postoperative days when compared with the posterior approach. As such, the authors of the study advised that abdominal pannus size “should not dictate surgical approach.”

Dr. Bialek’s coauthors of “Abdominal Pannus Size Should Not Dictate Surgical Approach in Primary Total Hip Arthroplasty” are Audrey K. Mustoe, BA; Nicholas M. Brown, MD, FAAOS; and Robert R. Burnham, MD.

Cailin Conner is the associate editor of AAOS Now.