Endoscopic Arthroplasty via Mini‐open Direct Anterior Approach Improves Postoperative Complications and Acetabular Components of Total Hip Arthroplasty in Obese Patients

To overcome the high‐risk complications and poor alignment of acetabular components in obese patients associated with direct anterior approach (DAA) for total hip arthroplasty (THA), we innovated an endoscopic arthroplasty via mini‐open direct anterior approach technique (Endo‐DAA). The purpose of this study was to compare the clinical and radiographic outcomes in obese patients subjected to THA between Endo‐DAA, Bikini DAA, and conventional DAA. In this retrospective controlled study, a total of 360 consecutive primary THA on obese patients (body mass index greater than 28 kg/m2) via Endo‐DAA, Bikini DAA, and conventional DAA performed from October 2017 to October 2022 by different surgeons and in a single center were included. Assessments including perioperative parameters, clinical outcomes, complications, and radiologic measurements were retrieved from patients before the surgery, perioperative period and the latest follow‐up. A total of 360 consecutive THA (Endo‐DAA = 108, Bikini DAA = 116, Conventional DAA = 136) with complete follow‐up data were analyzed. Compared to Bikini DAA or conventional DAA, Endo‐DAA significantly shortened the length of incision (5.46 ± 0.53), the duration of operation (64.47 ± 12.38), and postoperative hospital stay (2.15 ± 0.89). Endo‐DAA significantly reduces wound related complications compared with conventional DAA. Besides, Endo‐DAA achieved a significantly better alignment of acetabular components compared to Bikini DAA or conventional DAA. Furthermore, Endo‐DAA improved postoperative pain at the activity at 24 h postoperatively and early functional scores. The Endo‐DAA THA technique provides better short‐term clinical and radiographic results in obese patients with a low rate of postoperative complications compared to Bikini DAA or conventional DAA.