Systematic Review of Wound Complications After Direct Anterior Approach Total Hip Arthroplasty: Incidence, Risk Factors, and Management Strategies

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.