Introduction: Many studies have demonstrated objective patient data such as BMI, HgbA1C, and age that are correlated to adverse outcomes in total joint arthroplasty. BMI does not give the surgeon an accurate representation of the adipose and soft tissue distribution of the patient. Our study questions if the radiographic position of the pannus at different points compared to the pubic symphysis correlates with postoperative complications and inpatient data. 

Methods: We retrospectively reviewed patients who underwent primary anterior total hip arthroplasty by multiple surgeons at a single institution from 2015-2020. The level of the pannus in relation to the pubic symphysis was assessed on supine AP pelvis films. The pannus was noted to be either above, between the upper and lower borders, or below the level of the pubic symphysis. Analysis was carried out using fisher’s exact test to determine odds ratios and a P Value of < 0.05 was considered to indicate a significant difference. 

Results: 600 patients were included in the study. Patients with a pannus sign of 1 had a lower average operating time (117.57 mins vs. 128.24 mins, P 1. 10 readmissions were due to infection; 7/10 were in patients with a pannus sign 2 and 3, 3/10 were in patients with a pannus sign 1; odds ratio of 10.96 (P<0.01). No Fractures occurred in patients with a pannus sign 1, whereas 5 occurred in patients with Pannus sign 2 and 3 (P<0.01).

Conclusion: The pannus sign gives surgeons an efficient, easy, and reliable radiographic assessment tool to help with patient selection as well as counsel patients on their increased risk of periprosthetic fracture and infection for those undergoing anterior total hip arthroplasty.

Atul Saini is a board-certified orthopedic surgeon, fellowship-trained in adult reconstruction. He focuses on non-surgical treatment (physical therapy, bracing, injections, orthobiologics, medications) as well as surgical treatments (primary and revision hip and knee replacements). He has further training in robotic-assisted and computer-navigated joint replacement, anterior and posterior hip replacement using minimally invasive techniques. He believes in shared decision making with his patients through open communication and taking time to educate patients on their condition.