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

Abstract

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.

Intraoperative femoral head dislodgement during total hip arthroplasty: a report of four cases

“…However, all patients in our series were obese with a BMI of 37.3 kg/m 2 (range 30.1-46.1 kg/m 2 ). Increased BMI is a significant risk factor for THA instability and dislocation [21] , [22] , [23] , which may cause increased impingement on the posterior acetabular brim and subsequent modular component disassociation. Intraoperative soft tissue tension may be greater with decreased visualization in obese patients further increasing the likelihood of this complication.…”

Direct anterior approach vs Hardinge in obese and nonobese osteoarthritic patients: A randomized controlled trial

“…The selection of the best surgical approach for THA remains a matter of debate. While Hardinge is widely used, mainly due to its reduced dislocation rate[ 17 ], DAA is gaining popularity as its intermuscular pathway preserves soft tissues, ensuring an excellent functional outcome and reduced postoperative pain[ 4 ]. Our results are in line with other studies which suggest that DAA is more beneficial to the patients in terms of postoperative pain relief and faster recovery, than Hardinge[ 30 ].…”

“…The data are considered controversial and further studies need to be performed on obese patients, especially comparative evaluations that compare minimally invasive techniques such as DAA with classical surgical techniques, such as the Hardinge approach (HA). The Hardinge was chosen because, compared to other classical surgical approaches used in obese patients, it offers better access to the hip joint and achieves a lower rate of dislocation by preserving the joint's posterior stabilizer muscles[ 17 ].…”

The exploration of the differences between two surgical approaches in total hip arthroplasty, direct anterior minimal invasive surgery and Hardinge’s approach, in obese and non-obese hip osteoarthritic patients

“…The HA was chosen because, compared to other classical surgical approaches used in obese patients, it offers good access to the hip joint and achieves a lower rate of dislocation by preserving the joint's posterior stabilizer muscles. [16] The aim of this trial is to compare DAMIS and ΗΑ in hip OA patients undergoing primary THA, with regard to pain levels, functional status and quality of life. In addition, it will investigate whether these parameters differ between obese and non-obese patients.…”