Time to Clinical Dryness and Wound Outcomes After Drainless DAA Total Hip Arthroplasty With Standardized Multilayer Symmetric PDS Plus Closure: Bikini Versus Longitudinal Incisions.

Abstract

Objective: In direct anterior approach total hip arthroplasty (DAA-THA), the inguinal incision is prone to superficial wound problems. This study evaluated the feasibility and short-term wound outcomes of standardized drainless multilayer closure using Symmetric PDS Plus for fascial and subcutaneous closure. Secondary aims were to compare longitudinal and bikini incisions and assess time to clinical dryness as a monitoring metric.

Methods: This retrospective cohort included 168 primary unilateral DAA-THA patients treated between January 2023 and July 2025. All received continuous fascial and subcutaneous closure with Symmetric PDS Plus without routine drainage, including 115 longitudinal and 53 bikini incisions. Outcomes included wound complications within 3 months, Clavien-Dindo classification, deep closure time, time to clinical dryness, postoperative pain, Patient and Observer Scar Assessment Scale scores, Harris Hip Scores, and exploratory logistic regression for factors associated with wound complications. Propensity score overlap weighting was used as a sensitivity analysis.

Results: Mean deep closure time was 12.2 ± 2.0 min. The bikini group had a statistically longer closure time than the longitudinal group (13.0 ± 1.6 vs. 11.8 ± 2.1 min, p < 0.001), but the absolute difference was small. Wound complications occurred in 17 patients (10.1%), mostly Clavien-Dindo grades I and II; three cases (1.8%) were grade IIIa. No deep infection, periprosthetic joint infection, or fascial dehiscence occurred. Complication rates were similar between incision groups (9.6% vs. 11.3%, p > 0.05). Mean time to clinical dryness was 1.7 ± 2.2 days and was longer in patients with delayed healing or complications than in those without complications (7.1 ± 3.7 days vs. 1.1 ± 0.2 days, p < 0.001). Pain scores and three-month Harris Hip Scores were comparable. Observer scar scores were similar, whereas the bikini group reported higher satisfaction with scar appearance and concealment. In exploratory multivariable analysis, rheumatic disease and diabetes were associated with increased odds of wound complications. Overlap weighting achieved covariate balance without materially altering the between-group results.

Conclusions: This retrospective cohort suggests that standardized drainless multilayer Symmetric PDS Plus closure is feasible for DAA-THA wound management and was associated with early clinical dryness and mostly minor wound events. Because no conventional closure control group was included, superiority over other closure techniques cannot be inferred. Time to clinical dryness may serve as a simple monitoring marker, but its independent predictive value requires prospective validation. In patients with wound-healing risks, incision selection should prioritize wound safety over cosmetic preference.