Dual Mobile Total Hip Replacement in Super Obesity: A Case Report and Review of Literature

Abstract

Introduction:More than 13 million people in the US are morbidly obese. It is associated with various medical and anesthetic complications. Higher rate of dislocation in total hip replacement (THR) associated with morbid obesity due to thigh girth, low muscle mass and high-fat content. Morbid obesity is associated with a 38% increase in the 10-year mortality rate compare to non-obese after undergoing primary total hip arthroplasty (THA). Hip dislocation after THR is one of the earliest complications, and for every ten-point increase in BMI, the risk of dislocation increases by 113.9%. Case Report: We present a case report of a 69-year-old super-obese woman with a BMI of 62.2, who presented with repeated dislocation post THR. The patient was managed successfully with implant removal and implantation of dual mobile THR prosthesis. Conclusion: Morbid obesity with a need for arthroplasty is challenging. It needs proper planning, thorough preoperative preparation, proper intraoperative care and identification with adequate post-operative complications management. Preoperative bariatric surgery, dual mobile liner and constrained implants have shown good result in decreasing dislocation rate. The liner of dual mobile THR is efficient to prevent post-operative dislocation in morbidly obese and super-obese patients. Keywords: Dual mobile total hip replacement, super obesity, morbid obesity, bariatric surgery, hip arthroplasty, neck of femur fracture, revision hip arthroplasty.