Does Body Mass Index Affect The Early Outcome of Primary Total Hip Arthroplasty?

Moran, Matthew D.; Walmsley, P; Gray, Avia; Brenkel, Ivan J.

doi:10.1016/j.arth.2005.02.008

Cited by 82 publications

(87 citation statements)

References 14 publications

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“…In particular, morbidly obese patients (BMI >40) had a statistically significant higher risk of dislocation [3,15]. By contrast, other studies did not find evidence of an increased rate of dislocation caused by obesity after THA [14,15].…”

Section: Introductionmentioning

confidence: 56%

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Obese patients may have more soft tissue impingement following primary total hip arthroplasty

Hayashi

Nishiyama

Fujishiro

et al. 2012

International Orthopaedics (SICOT)

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Purpose Several studies have reported a risk of dislocation in obese patients after total hip arthroplasty. In this study, we evaluated the interaction between obesity and dislocation by kinematic analysis using a navigation system. Methods The intraoperative range of motion (ROM) and postoperative impingement-free ROM were measured in 38 patients, and we compared the impingement-free ROM in obese and non obese patients. Results The postoperatively simulated ROM was similar in the obese and non obese groups. The intraoperative ROM was smaller in the obese group. The difference values between the intraoperative ROM and postoperatively simulated ROM were larger in the obese group. These results indicate that obese patients have less ROM following primary total hip arthroplasty even when the implant positioning is performed correctly. Conclusions Dislocations are multifactorial problems including soft tissue impingement. Therefore, the risk of dislocation caused by soft tissue impingement in obese patients may be increased.

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Section: Introductionmentioning

confidence: 56%

“…Several studies have attempted to clarify the interaction between obesity and dislocation following THA [14][15][16]. Azodi et al demonstrated that a high body mass index (BMI) increased the risk of dislocation after THA [16].…”

Section: Introductionmentioning

confidence: 99%

Obese patients may have more soft tissue impingement following primary total hip arthroplasty

Hayashi

Nishiyama

Fujishiro

et al. 2012

International Orthopaedics (SICOT)

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“…However, large studies to determine the effect size of morbid obesity on early postoperative complications after THA or TKA are lacking. Other studies have not found an association between BMI and the risk of complications in patients undergoing THA or TKA [1,16,17,23].…”

Section: Introductionmentioning

confidence: 93%

Complication Rates After Hip or Knee Arthroplasty in Morbidly Obese Patients

Friedman¹,

Hess

Berkowitz

et al. 2013

Clinical Orthopaedics &Amp; Related Research

173

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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.

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“…According to Bourne et al [4], the Canadian Joint Replacement Registry showed an 8.56-fold increased risk for a patient with class III obesity (BMI[40 kg/m 2 ) to undergo a total hip replacement. There is controversy regarding whether obesity poses additional complications and costs with THA [7,20,28]. Some studies have reported that the risk of postoperative complications after joint arthroplasty in patients who are obese is comparable to the risk in patients who are nonobese as long as their BMI is less than 40 kg/m 2 [1,17].…”

Section: Introductionmentioning

confidence: 99%

Surgical Risks and Costs of Care are Greater in Patients Who Are Super Obese and Undergoing THA

Meller¹,

Toossi

Gonzalez

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Patients with morbid obesity, defined as a BMI greater than 40 kg/m 2 , and super obesity, defined as a BMI greater than 50 kg/m 2 , increasingly present for total hip replacement. There is disagreement in the literature whether these individuals have greater surgical risks and costs for the episode of care, and the magnitude of those risks and costs. There also is no established threshold for obesity as defined by BMI in identifying increased complications, risks, and costs of care. Until recently, analysis of higher BMI data was limited to small cohorts from hospital-based data banks, based on BMI or height and weight only, often as part of a multivariate analysis. On October 1, 2010 the Centers for Medicare & Medicaid Services added a fifth digit to the BMI data, V85.xx, in the Medicare data bank, which allowed data mining of cases of patients with higher BMI. To our knowledge, our study is the first large retrospective Medicare data mining study, which allows us to examine BMI levels greater than 40 and 50 kg/m 2 to delineate risks, complications, and costs for these patients. Questions/purposes We sought to quantify (1) the surgical risk, and (2) the costs associated with complications after THA in patients who were morbidly obesity (BMI C 40 kg/m 2 ) or super obese (BMI C 50 kg/m 2 ). Methods This is a retrospective study of patients, using Medicare hospital claims data, who underwent THA. The ICD-9 Clinical Modification (CM) diagnosis code V85.4x was used to identify patients with morbid obesity and with super obesity from October 1, 2010 through December 31, 2014. Patients without any BMI-related diagnosis codes were used as the control group. Twelve complications occurring during the 90 days after THA were analyzed using multivariate Cox models adjusting for patient demographic, comorbidities, and institutional factors. In addition, hospital charges and payments were compared from primary surgery through the subsequent 90 days.Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved or waived approval for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research. This study was performed via electronic collaboration at the authors' institutions. (HR, 3.91; 95% CI, 3.14-4.86; p \ 0.001). In addition, patients with morbid obesity had increased risk of deep vein thrombosis (HR, 1.43; 95% CI, 1.14-1.79; p \ 0.002), pulmonary embolism (HR, 1.57; 95% CI, 1.25-1.99; p \ 0.001), implant failure (HR, 1.48; 95% CI, 1.3-1.68; p \ 0.001), acute ...

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Does Body Mass Index Affect The Early Outcome of Primary Total Hip Arthroplasty?

Cited by 82 publications

References 14 publications

Obese patients may have more soft tissue impingement following primary total hip arthroplasty

Obese patients may have more soft tissue impingement following primary total hip arthroplasty

Complication Rates After Hip or Knee Arthroplasty in Morbidly Obese Patients

Surgical Risks and Costs of Care are Greater in Patients Who Are Super Obese and Undergoing THA

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