Higher Incidence of Venous Thromboembolism in Anterolateral Approach in Lateral Position Compared to Anterolateral Supine and Direct Anterior Approaches in Minimally Invasive Total Hip Arthroplasty

TL;DR

This study found that the anterolateral approach in hip surgery leads to a higher risk of blood clots compared to other approaches.

Contribution

The study compares VTE incidence across three minimally invasive THA approaches, revealing higher risk with the anterolateral approach.

Findings

The anterolateral approach had a 30% VTE rate, significantly higher than the 17% in ALS and 16% in DAA.

VTE on the non-operated side was 22% in AL, compared to 9% in ALS and 8% in DAA, showing a significant difference.

No significant differences were found in VTE on the operated side across the three approaches.

Abstract

Introduction: Venous thromboembolism (VTE) remains a major complication after total hip arthroplasty (THA), irrespective of the surgical approach. This study investigated the incidence of VTE in patients undergoing THA through intermuscular minimally invasive surgical techniques, which included a direct anterior approach (DAA), an anterolateral approach (AL), and an anterolateral supine approach (ALS), at a single institution.

Methods: A hundred consecutive patients treated with each surgical approach were evaluated. Plasma D-dimer levels one month preoperatively and one day postoperatively, operative time, and intraoperative blood loss were recorded, and the presence of VTE was evaluated based on multidetector-row computed tomography performed the day after surgery. Student’s t-test and Pearson’s chi-square test or one-way analysis of variance were used in statistical analysis.

Results: No differences among the groups in terms of age, height, weight, operative time, intraoperative bleeding, and preoperative and postoperative D-dimer levels were observed. The overall incidence of VTE was 21%. The incidences of VTE were 30% in AL, 17% in ALS, and 16% in DAA, representing a significantly higher rate in AL than in ALS and DAA (P=0.025). The incidences of VTE on the operated side were 19% in AL, 13% in ALS, and 12% in DAA, with no statistically significant differences. The incidences of VTE on the non-operated side were 22% in AL, 9% in ALS, and 8% in DAA; these differences were statistically significant (P=0.0045).

Discussion: Results showed that the incidence of VTE was significantly higher in AL than in ALS and DAA, especially for the non-operated side.

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