• Author
    David Chukwu
  • Discovery PI

    Alexandra I. Stavrakis MD

  • Project Co-Author

    Nora A. Galoustian BA, Tony Lam BA, Timothy Ko BS, Ava Jafarpour BS, Sumin Jeong BSN, Alexander B. Christ MD, Erik N. Zeegen MD

  • Abstract Title

    Pre-Operative CT Subcutaneous Tissue Depth Better Predicts 90-Day Post-Operative Complication Rates in Patients Undergoing Anterior Total Hip Arthroplasty

  • Discovery AOC Petal or Dual Degree Program

    Basic, Clinical, & Translational Research

  • Abstract

    Background: Body mass index (BMI) is commonly used to assess complication risk following total hip arthroplasty (THA), but may inadequately reflect soft tissue distribution. Subcutaneous tissue depth (SubTD) has been shown to better predict complications in posterior THA; however, its role in anterior THA remains unclear. This study aimed to evaluate whether SubTD at the anterior surgical interval is a superior predictor of postoperative complications compared to BMI. We hypothesized that increased SubTD would be independently associated with higher complication rates, whereas BMI would not.

    Methods: A single-institution retrospective cohort study was performed on patients undergoing anterior THA from 2021–2025. Preoperative computed tomography scans were used to measure SubTD between the tensor fascia latae and sartorius. The primary outcome was 90-day postoperative complications. Unadjusted analysis utilized independent t-tests for continuous variables and chi-square tests for categorical variables. Multivariable logistic regression models were then constructed to determine the independent association of each predictor while adjusting for confounders.

    Results: A total of 661 patients were included (mean age 67.0±11.1 years). Patients with 90-day complications had significantly greater SubTD compared to those without complications (1.85±1.46 cm vs 1.46±1.04 cm, p<0.001). This association remained significant after adjusted analysis (OR 1.20, 95% CI 1.02–1.41, p=0.027). In contrast, BMI was not associated with complications in either unadjusted (p=0.088) or adjusted analyses (OR 1.02, 95% CI 0.94–1.10, p=0.696). Patients with complications were also older and had higher ASA scores and rates of diabetes (all p<0.001). 

    Conclusion: SubTD is an independent predictor of 90-day postoperative complications following anterior THA, whereas BMI is not. This may be attributed to the fact that BMI does not account for fat distribution, whereas SubTD is a direct measurement of tissue depth at the incision site. These findings suggest that SubTD may provide improved risk stratification by directly measuring tissue characteristics at the surgical site. Incorporating SubTD into preoperative planning may enhance patient selection and optimization.

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