Early Results of Total Hip Arthroplasty in the Super-Obese Patients

Issa, Kimona; Wohl, Hirschel; Naziri, Qais; McDermott, James D.; Cherian, Jeffrey J.; Mont, Michael A.

doi:10.1615/jlongtermeffmedimplants.2013010098

Cited by 9 publications

(8 citation statements)

References 11 publications

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“…9,10 More recently, results of "super-obese" patients (BMI > 50 kg/m 2 ) undergoing total hip and knee arthroplasty have been described as being suboptimal. 11,12 Currently, many hip surgeons are reluctant to operate on patients who are obese for fear of an increased risk of perioperative complications, including infection, 13 thromboembolic disease, 14 revision surgery, 15 dislocation, 16 com-e573 ponent malposition, 17 aseptic loosening, 18 and prolonged hospital stay. 19 However, an accepted "cut-off" BMI currently does not exist among hip surgeons.…”

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confidence: 99%

Patient-Reported Outcomes Following Total Hip Arthroplasty Stratified by Body Mass Index

Wu¹,

Cherian²,

Jauregui³

et al. 2016

Orthopedics

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Obese patients undergoing total hip arthroplasty have been shown to have less functional recovery. This study prospectively compared temporal trends in patient-reported outcomes and activity levels between patients with a body mass index (BMI) of less than 30, 30 to 35, and 35 to 40 kg/m(2) after total hip arthroplasty. Patients were evaluated via the Harris Hip Score, Lower Extremity Activity Scale, and Short Form-12 physical and mental components. The results suggest that patients with BMIs of 35 to 40 kg/m(2) might have poorer functional outcomes preoperatively, with function returning more slowly or poor function being sustained and their not reaching other cohorts' levels. Surgeons must counsel these patients regarding functional expectations and the potential for slower functional returns. [Orthopedics. 2016; 39(3):e572-e577.].

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confidence: 99%

Patient-Reported Outcomes Following Total Hip Arthroplasty Stratified by Body Mass Index

Wu¹,

Cherian²,

Jauregui³

et al. 2016

Orthopedics

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“…Our quality assessment identified 2 prospective studies, 6 retrospective studies with a matched comparison group, and 2 retrospective studies with a controlled analysis (Table I); the remaining 23 studies were retrospective studies without a matched comparison group or controlled analysis 5,8,10,[12][13][14] . Biases due to selection and missing data were the most frequent.…”

Section: Resultsmentioning

confidence: 99%

Revision Rates and Functional Outcome Scores for Severely, Morbidly, and Super-Obese Patients Undergoing Primary Total Hip Arthroplasty

et al. 2019

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Background: We performed a systematic review and meta-analysis of the literature to quantify the impact of patients with severe obesity (body mass index [BMI] . 35 kg/m 2 ), those with morbid obesity (BMI . 40 kg/m 2 ), and those with super-obesity (BMI . 50 kg/m 2 ) on revision rates and outcome scores after primary total hip arthroplasty compared with non-obese patients (BMI , 25 kg/m 2 ).Methods: Four electronic databases were reviewed (AMED, Embase, Ovid Healthstar, and MEDLINE) from their inception to August 2016. The search strategy used combined and/or truncated keywords, including hip replacement or arthroplasty and obesity, BMI, or any synonym of the latter in the title, abstract, or manuscript text. Abstracts and full text were reviewed by 3 pairs of reviewers to identify those assessing outcomes following primary total hip arthroplasty for different BMI categories. Outcomes evaluated were revisions (total, aseptic, and septic) and change in outcome scores (preoperative to postoperative). Results:The literature search identified 1,692 abstracts; 448 were included for the full-text review, and 33 were included in the meta-analysis. The morbidly obese and super-obese groups were at an increased risk for revision, especially for septic revisions, compared with the non-obese group. The severely obese group had risk ratios of 1.40 (95% confidence interval [CI], 0.97 to 2.02) for revision, 0.70 (95% CI, 0.45 to 1.10) for aseptic revision, and 3.17 (95% CI, 2.25 to 4.47) for septic revision. Morbidly obese patients had risk ratios of 2.01 (95% CI, 1.81 to 2.23) for revision, 1.40 (95% CI, 0.84 to 2.32) for aseptic revision, and 9.75 (95% CI, 3.58 to 26.59) for septic revision. Super-obese patients had risk ratios of 2.62 (95% CI, 1.68 to 4.07) for revision, 1.98 (95% CI, 0.80 to 4.94) for aseptic revision, and 7.22 (95% CI, 1.51 to 34.60) for septic revision. However, there was no significant difference (p . 0.05) in the standardized mean difference of functional outcome scores between the severely obese cohort (0.04 [95% CI, 20.02 to 0.10]), the morbidly obese cohort (0.19 [95% CI, 20.08 to 0.46]), and the super-obese cohort (20.12 [95% CI, 20.57 to 0.33]).Conclusions: Severely obese patients, morbidly obese patients, and superobese patients undergoing total hip arthroplasty should be counseled that, although they have comparable outcome score improvements compared Disclosure: There was no source of external funding for this study. On the Disclosure of Potential Conflicts of Interest forms, which are provided with the online version of the article, one or more of the authors checked "yes" to indicate that the author had a relevant financial relationship in the biomedical arena outside the submitted work (http://links.lww.com/JBJSREV/A440).

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“…However, these patients may benefit from a discussion with their orthopedic surgeons to develop realistic expectations from the outcomes of their arthroplasty procedure. 9 While this is not a comparative study comparing other techniques with the standard procedures, we do plan to follow this cohort to assess medium and long term outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies and current meta analyses report a higher risk of total hip replacements (THA) when being performed in obese patients. Factors associated with THA in these patients and potential complications comprise increased risk for re-operation and infection, 4-6 prolonged operating room (OR) time, 7 , 8 expectations of poorer clinical outcomes, 9 risk of component malpositioning 10 and risk of dislocation. 11 In order to reduce these risks, measures such as pre-operative weight loss regimes 12 and avoiding the use of minimally invasive approaches have been advocated.…”

Section: Introductionmentioning

confidence: 99%

Hip arthroplasty in obese patients: rising prevalence – standard procedures?

2016

Orthop Rev

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We examined our experience and, in particular, complications associated with total hip arthroplasty in obese and morbidly obese patients. We prospectively gathered 50 patients in a matched control series including 25 obese and morbidly obese patients. All patients were operated using the direct lateral approach and standard postoperative protocols. Operating room time, complications, dislocations, blood loss, cup position and clinical parameters using the Harris Hip Score and the Western Ontario and McMaster Universities Arthritis Index results were compared. Although there were some significant differences in clinical outcomes, standard procedures yielded good overall results and an acceptable rate of complications. Details approaching this patient entity are being discussed.

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Early Results of Total Hip Arthroplasty in the Super-Obese Patients

Cited by 9 publications

References 11 publications

Patient-Reported Outcomes Following Total Hip Arthroplasty Stratified by Body Mass Index

Patient-Reported Outcomes Following Total Hip Arthroplasty Stratified by Body Mass Index

Revision Rates and Functional Outcome Scores for Severely, Morbidly, and Super-Obese Patients Undergoing Primary Total Hip Arthroplasty

Hip arthroplasty in obese patients: rising prevalence – standard procedures?

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