Outcomes of morbidly obese patients undergoing total hip arthroplasty with the anterior-based muscle-sparing approach (original) (raw)
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Medicina
Background and objective: There is a general clinical concern on the negative impact of obesity on surgical complications and functional outcomes. We hypothesized that the patients with morbid obesity are exceptionally prone to a significantly increased risk for surgical and short-term complications after primary total hip arthroplasty (THA). We aimed to identify the range of Body Mass Index (BMI) values of patients with a significant risk for lower functional improvement after THA. Materials and methods: In Stage 1 of the study, we conducted a retrospective comparative analysis of the rate of complications and functional outcomes in patients treated by primary THA, with normal weight (BMI 19–25, N = 1205) vs. Class 1 (BMI 26–34, N = 450), Class 2 (BMI 35–39, N = 183), and Class 3 (BMI ≥ 40, N = 47) obese patients. After the statistical similarity rates of complications and 6- and 12-month functional outcomes (by Harris Hip and SF-36 scores) were revealed in Class 1 patients and pat...
Total hip arthroplasty outcomes in morbidly obese patients
EFORT Open Reviews
The increasing prevalence of obesity has resulted in a marked increase in the number of total hip arthroplasties (THAs) carried out in patients with a high body mass index (BMI). THA in morbidly obese patients is often technically challenging owing to the associated co-morbidities and anatomical factors. Furthermore, the long-term clinical and functional outcomes of the procedure in these patients are not clear. The aim of this systematic review was to compare the long-term failure rate and functional outcomes of THA in morbidly obese versus non-obese patients. A literature search of PubMed, EMBASE and PubMed Central was conducted to identify studies that compared the outcomes of THA in patients defined as morbidly obese (BMI ≥ 35) to a control group (BMI…
Obesity in total hip arthroplasty—does it really matter?
Acta Orthopaedica, 2012
Background and purpose Discussion persists as to whether obesity negatively influences the outcome of hip arthroplasty. We performed a meta-analysis with the primary research question of whether obesity has a negative effect on short-and long-term outcome of total hip arthroplasty.
Obesity is associated with higher complication rates in revision total hip arthroplasty
Journal of orthopaedics, 2018
We examined differences in complication rates between obese and non-obese patients undergoing revision total hip arthroplasty. Sixty-five patients with a BMI ≥30 kg/m and 54 patients with a BMI of <30 kg/m were identified. Obese patients were 2.5 times more likely to suffer a complication than non-obese (38.4% 14.8%, p = 0.02). Obese patients were more likely to experience dislocation, leg length discrepancy, fracture, implant loosening, infection and pulmonary embolus. The obese group had a significantly higher revision rate (12.3% 1.8%, p = 0.039). Obese patients should be counselled pre-operatively on their elevated risk.
Arthroplasty
Background The prevalence of obesity in total hip arthroplasty (THA) patients has been studied in the past. However, there has not been direct comparison against obesity in the general population. This study compared yearly trends in BMI and obesity rates between patients who had undergone primary THA and those from the general patient population. Methods We retrospectively reviewed all patients over the age of 18 who underwent primary, elective THA and those who had an annual routine physical exam between January 2013 and December 2020 at our academic tertiary medical center. Baseline demographics were controlled in our statistical models. Significance of yearly trends was determined through a linear regression analysis. Independent samples t-test and Chi-square test were used to compare means and proportions between the two groups, respectively. Results A total of 11,250 primary THA patients and 1,039,918 annual physical exam patients were included. Average BMI for the THA group w...
Outcomes of obese and nonobese patients undergoing revision total hip arthroplasty
Arthritis & Rheumatism, 2008
To evaluate the effect of obesity on the incidence of adverse events (surgical site infection, dislocation, re-revision, or >1 adverse event), functional outcome, residual pain, and patient satisfaction after revision total hip arthroplasty (THA). Methods. We conducted a university hospital-based prospective cohort study including 52 obese and 152 nonobese patients with revision THA performed between 1996 and 2006. We used incidence rates, rate ratios, and hazard ratios (HRs) to compare the incidence of events in obese and nonobese patients and in 4 body mass index (BMI) categories (<25, 25-29.9, 30 -34.9, >35). Functional outcome and pain were measured 5 years postoperative using the Harris Hip Score. Results. The incidence rate for >1 complication increased with rising BMI (1.8, 3.4, 10.3, and 17.9 cases/100 personyears). The increase was small between normal and overweight patients (adjusted HR 1.5, 95% confidence interval [95% CI] 0.5, 4.7), significantly greater with BMI 30 -34.9 (adjusted HR 4.5, 95% CI 1.4, 14.0), and most evident with BMI >35 (adjusted HR 10.9, 95% CI 2.9, 41.1). The adjusted HR for surgical site infection (obese versus nonobese) was 4.1 (95% CI . Eighty patients had a followup visit at 5 years. Obese patients had moderately lower functional results and higher levels of residual pain, but patient satisfaction was almost similar. Conclusion. Revision THA is technically challenging, particularly in obese patients, probably due to more difficult anatomic conditions. We found an increased risk of adverse events, notably surgical site infection and dislocation in these patients.
The Influence of Obesity on Early Outcomes in Primary Hip Arthroplasty
The Journal of Arthroplasty, 2012
Obesity is considered an independent risk factor for adverse outcome after arthroplasty surgery. Data on 191 consecutive total hip arthroplasties were prospectively collected. Body mass index (BMI) was calculated for each patient and grouped into nonobese (BMI b30 kg/m 2 ), obese (BMI 30-34.9 kg/m 2 ), and morbidly obese (BMI ≥35 kg/m 2 ). Primary outcomes included functional improvement (Oxford hip score, 6-minute walk test and Short Form-12 Health Survey general health questionnaire) and postoperative complications. Subgroup analysis of surgeons' overall perception of operative technical difficulty was also performed. This study shows that total hip arthroplasties in obese patients were perceived, by the surgeon, to be significantly more difficult. However, this did not translate to an increased risk of complications, operation time, or blood loss, nor suboptimal implant placement. In addition, our results suggest that obese patients gain similar benefit from hip arthroplasty as do nonobese patients, but morbidly obese patients have significantly worse 6-minute walk test scores at 6 weeks.
Association between obesity and inpatient adverse events following primary hip or knee arthroplasty
Osteoarthritis and Cartilage, 2015
Purpose: Obesity is a significant risk factor in the development and progression of osteoarthritis in weight-bearing joints. Obese people (body mass index (BMI) of 30 or greater) make up the majority of hip and knee arthroplasty patients. Nevertheless, there is inconclusive evidence on the association between obesity and outcomes following elective hip or knee arthroplasty. We examined patient data in Alberta to quantify the association between obesity and inpatient adverse events. Methods: We reviewed 9,265 records of patients who had elective primary hip or knee arthroplasty by 68 orthopaedic surgeons during the period from September 2010 to April 2014 in Alberta, Canada. Patient characteristics such as age, gender, procedure type, BMI, co-morbidities and in-hospital adverse events were collected from electronic medical records, operating room information systems, the discharge abstract database, provincial clinical risk grouper data, and provincial surgical site infection surveillance data. We evaluated 12 in-hospital adverse events, which were classified as either Medical Adverse Events (myocardial infarction, pulmonary embolism (PE), deep vein thrombosis, cerebro-vascular accident, illeus, gastro-intestinal bleeding, pneumonia, and complex infection), or Mechanical Adverse Events (fracture, dislocation, fracture after insertion, and other mechanical complications). Deep incisional and organ/space infections were grouped with complex infection. We used logistic regression analyses to compare adverse events for obese (BMI 30) and non-obese patients, and risk-adjusted for age, gender, procedure type, and co-morbidities. The significance level was set at 0.05. Results: Of the 9,265 patients, 59.2% had total knee arthroplasty, 35.3% had total hip arthroplasty, 5.5% had hip resurfacing or partial knee arthroplasty, and 56.2% were obese (BMI 30). Mean age was 66.3 years, 57.7% were female, and mean baseline WOMAC score was 42.3. After controlling for age, gender, procedure type, and co-morbidities, the odds of Medical Adverse Events were 1.4 times higher for obese patients compared to non-obese patients (adjusted odds ratio [OR]¼1.4, 95% confidence interval [CI] [1.1-1.9], p¼0.016). The odds of complex infection were 2.7 times higher for obese patients compared to nonobese patients (adjusted OR¼2.7, 95% CI [1.4-5.2], p¼0.003). Among patients with no history of thromboembolic disease, the odds of PE were 1.7 times higher in the obese cohort (adjusted OR¼1.7, 95% CI [1.2-2.4], p¼0.007). There were no statistically significant differences between the cohorts in Mechanical Adverse Events (adjusted OR¼0.9, 95% CI [0.5-1.7], p¼0.742) during the hospital stay. Conclusions: Obese patients are at significantly elevated risk of inpatient Medical Adverse Events, especially PE and complex infection, but we were unable to detect increased risk of Mechanical Adverse Events. This finding, based on preliminary data in Alberta, suggests continued research is warranted to identify modifiable risk factors within the growing population of obese lower limb arthroplasty patients. The results will provide clinicians with evidence to support the development and implementation of risk-reduction protocols tailored to obese patients. These findings may also reinforce the importance of pre-surgical weight management for patients considering elective hip or knee arthroplasty.
Body mass index and in-hospital postoperative complications following primary total hip arthroplasty
HIP International, 2018
Background: The influence of obesity measured in terms of body mass index (BMI) on the complication rates following total hip arthroplasty (THA) is a matter of debate. Methods: This retrospective study conducted at a tertiary referral centre at Brisbane, Australia, examines the association between BMI and in-hospital postoperative complications, length of operating time and duration of hospital stay in 964 patients, who underwent THA from 2006 to 2010. Results: Amongst patients undergoing primary THA, when compared to the normal weight patients, those with BMI between 25 kg/m 2 and 29.9 kg/m 2 (overweight) and those with BMI between 35 kg/m 2 and 39.9 kg/m 2 (obese class II) had lower odds of perioperative complications (odds ratio [OR]: 0.62 (95% confidence intervals [CI], 0.43-0.92, p = 0.016) and OR: 0.60 (95% CI, 0.36-0.99, p = 0.047 respectively). Patients with BMI less than or equal to 40 kg/m 2 were also associated with significantly lower odds of cardiac complications (p = 0.02). With unadjusted regression analysis, it was noted that those with BMI 40 kg/m 2 had the highest odds of developing infectious complications (OR 2.68, 95% CI, 1.08-6.65, p < 0.05). As the BMI increased, there was a statistically significant increase in length of operating time (p < 0.001). Conclusion: There is a significant impact of BMI on the occurrence of perioperative complications following THA. Compared to normal weight category, the overweight and obese class II patients had a lower likelihood of developing overall, especially cardiac complications. Length of operating time increases along with an increase in BMI.