Abstract
Introduction
The influence of surgical approach for total hip arthroplasty (THA) on scar healing and scar perception is unknown. The purpose of this study was to evaluate patients’ perception of their scar following direct anterior (DA) or posterior approach (PA) for THA utilizing validated scar assessment scales.
Methods
Fifty DA and 58 PA THA patients underwent scar assessment using the Patient Observer Scar Assessment Scale (POSAS) and Stony Brook Scar Evaluation Scales (SBSES). Patients were included if they had at least 1-year follow-up, and had no previous surgery or intervention (i.e. radiation) around the assessed hip. The mean age was different between the cohorts (DA 67 vs PA 62 years, p=0.03). Other variables including gender, BMI, Charlson Comorbidity Index, steroid use, diabetes, and smoking were similar (p>0.05 for all comparisons). All patients had subcuticular running closure, secured with skin adhesive glue. Mean time from THA to scar assessment was 3.1 and 3.6 years for the DA and PA groups, respectively (p=0.18).
Results
The overall opinion of the scar on the POSAS observer scale was graded as closer to normal skin more often for the PA than DA cohort (p=0.04). Age was not predictive of overall scar opinion on this scale (p=0.60). Scar vascularity, pigmentation, thickness, relief, pliability, and surface area were graded similarly (p>0.05 for all comparisons). For the POSAS patient scale, scar pain, itchiness, color, stiffness, thickness, or irregularities were graded similarly (p>0.05 for all comparisons). On the SBSES, there was no difference for scar width, height, color, and presence of hatch marks (p>0.05 for all comparisons). Overall scar appearance was rated as “good” in 94% of the DA and 91% of the PA patients (p=0.72).
Discussion/Conclusion
Scar healing is reported to resemble normal skin more often following a PA approach on a validated scar assessment scale. There were no other significant differences for other scar attributes.
Summary Statement
When comparing scar healing and perception after total hip arthroplasty, the posterior approach heals with more normal looking skin as assessed on a validated scare assessment scale.
