Scar Perception After Two Surgical Approaches for Total Hip Arthroplasty

Background: There is a paucity of literature examining patients’ and health-care providers’ perception of surgical scars after total hip arthroplasty (THA). This study examined perception of surgical scars after direct anterior (DAA) or posterior approach (PA) for THA using validated scar-assessment scales. Material and methods: Seventy-five DAA and 75 PA THA patients underwent scar assessment using the Patient Observer Scar Assessment Scale (POSAS) and Stony Brook Scar Evaluation Scales. Mean age was different between the cohorts (DAA 67 vs PA 62 years, P =.01). 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 DAA and PA groups, respectively (P =.18). Results: Scar opinion on the POSAS patient-reported scale was graded closer to normal skin more often for DAA than for PA patients (P =.03). More irregularities were graded for the DAA scars on the POSAS observer scale (P =.02) and the Stony Brook Scar Evaluation Scales (P =.04). Age did not predict scar opinion on any of the scales (P >.05). Female gender and a history of keloids predicted poorer scar appearance (P =.001 and P =.02). Overall scar appearance was rated as “good” in 93% of the DAA and 91% of the PA patients (P =.63). Conclusion: Differences exist in DAA and PA scar perception based on validated scales. Future randomized trials in scar assessment may control for confounding variables such as age and gender, as well as potential biases when using scar assessment scales.