Complication Rates After Hip or Knee Arthroplasty in Morbidly Obese Patients

Abstract

Background Morbid obesity has been shown to be a risk factor for increased complications after THA and TKA; however, large studies that would determine the effect size are lacking. Questions/purposes The purposes of this study were to determine whether morbid obesity increased the risk of: (1) venous thromboembolism (VTE), (2) bleeding, (3) other adverse events, and (4) infections during the early postoperative period (up to 6 to 8 weeks) after THA or TKA? Methods Data from the REgulation of Coagulation in ORthopaedic surgery to prevent Deep vein thrombosis and pulmonary embolism (RECORD) clinical trial program of rivaroxaban for prevention of VTE after THA or TKA were analyzed retrospectively. Data for 12,355 patients were reviewed to identify complication rates in morbidly obese patients (BMI C 40 kg/m 2 ) compared with patients with a BMI less than 40 kg/m 2 . Explorative analyses compared the rates of asymptomatic deep vein thrombosis (DVT), symptomatic DVT, symptomatic pulmonary embolism, bleeding, and other adverse events by BMI group. Results There were no significant differences in asymptomatic DVT, symptomatic DVT, symptomatic pulmonary embolism, or bleeding, but there were increases in other adverse events (including receipt of blood transfusion, erythema, peripheral edema, diarrhea, gastrointestinal or abdominal pain) and infections (including respiratory tract or lung infections, wound inflammation or infection, and extrasurgical-site infections), in patients with a BMI of 40 kg/m 2 or greater compared with patients with a BMI less than 40 kg/m 2 . Conclusions After THA or TKA, morbid obesity is not associated with an increased risk of VTE or bleeding but is associated with increased early postoperative complications, including erythema, peripheral edema, diarrhea and gastrointestinal or abdominal pain, wound inflammation or infection, extrasurgical-site infections, and respiratory tract or lung infections.

Morbid Obesity: Increased Risk of Failure After Aseptic Revision TKA

“…It is well documented that patients with obesity have more frequent complications and a greater risk of revision after primary TKA [4,5,14,15]. As the prevalence of obesity increases, these complications will continue to create The estimated survival free of subsequent revision was 81% (95% CI, 70%-92%) for the patients in the morbid obesity group and 93% (95% CI, 86%-100%) for patients in the nonmorbid obesity group at 10 years (p = 0.02).…”

“…Obesity not only is associated with an increased risk of knee osteoarthritis, but also with a younger age for primary TKA in patients who are obese than in patients who are not obese [22]. Furthermore, obesity is associated with a higher risk of postoperative complications and need for revision surgery after primary TKA, particularly in patients with morbid obesity (BMI C 40 kg/m 2 ) [5,11]. Revision TKA for aseptic failure provides reliable and durable improvement in patient pain and function, with long-term implant survival rates between 80% and 94% [2,7,9,12,20,23,25,26].…”

The use of anticoagulants in morbidly obese patients

“…Friedman et al [24] compared the efficacy of anticoagulation treatment with rivaroxaban (occurrence of asymptomatic/symptomatic deep vein thrombosis, pulmonary embolism, bleedings and other adverse effects in orthopedic surgery patients with BMI > 40 kg/m 2 and < 40 kg/m 2 [subanalysis of a group of 12,355 patients]). The authors observed no differences in the incidence rates of aforementioned disorders.…”

The effect of body weight on the choice of material for the bearing couple in artificial hip joints

“…затруднения в определении анатомических ориентиров при-водят к ятрогенным повреждениям или непра-вильной ориентации элементов протеза [29].…”