Total Hip Arthroplasty: Infection Rates Higher Using Direct Anterior Approach

Total Hip ArthroplastyIn March, the Hip Society presented the 2019 Frank Stinchfield Award to Richard Iorio, MD, and his co-authors, honoring research that compared prosthetic joint infection (PJI)  complication rates between the direct anterior approach (DA) and the non-anterior (NA) approach.

Among surgeons, there has been enormous interest in approaches to hip replacement that could offer quicker recovery and fewer complications. Anecdotal evidence abounds about what approach works best, but few studies have set out to distinguish myth from fact based on rigorous analysis.

At Brigham and Women’s Hospital, Dr. Iorio set out to address this knowledge gap. Dr. Iorio is chief of the Adult Reconstruction and Total Joint Arthroplasty Service in the Department of Orthopaedic Surgery and vice chairman of Clinical Effectiveness at the Brigham.

Dr. Richard Iorio
Dr. Richard Iorio, Chief, Adult Reconstruction and Total Joint Arthroplasty Service

“Hip replacement is a wonderful operation and recent advancements in pain management and infection prevention have improved all approaches and led to rapid recovery,” says Dr. Iorio. “Our study suggests that early enthusiasm for the newer direct anterior approach over non-anterior isn’t necessarily warranted. Although a good surgeon can do a great job with it, there appears to be a learning curve.”

In the study that won the 2019 Frank Stinchfield Award, Dr. Iorio and the research team compared the overall rates of infection for 1,985 patients who received direct anterior total hip arthroplasty and 4,101 patients who received non-anterior total hip arthroplasty.

The researchers found a higher rate of infection for the DA group (1.22 percent) versus the NA group (0.63 percent). Infection prevention protocols lowered rates for both groups. The authors also noted that the infection rate decreased over time, perhaps as surgeons gained experience in using the approach.

“I am very proud of Dr. Iorio for winning this coveted award in the field of joint arthroplasty,” says James Kang, MD, Chair of the Department of Orthopaedic Surgery at Brigham and Women’s Hospital. “The Hip Society gives awards to the most important and groundbreaking research teams in the world. I know that our entire Orthopaedic team will continue to lead cutting-edge research with more accolades to come.”

Dr. Iorio and colleagues now plan to embark on a multi-center, randomized trial of 1,000 patients to help determine which infection prevention protocols are most important for reducing infection rates. Brigham and Women’s Hospital will be one of the study sites.

Dr. Iorio speaks proudly of his colleagues in the Brigham’s Orthopaedics Department.

“We have some of the most innovative, up-and-coming arthroplasty surgeons in the country,” says Dr. Iorio. “The Brigham has a long history of leadership in arthroplasty, and Dr. Kang has re-energized the department. With advancements in basic and clinical research leading to improvements in practice, we’re going to keep that momentum going and bring the best possible care to our patients.”