Influence of Obesity on Femoral Osteolysis Five and Ten Years Following Total Hip Arthroplasty

Lübbeke, Anne; Garavaglia, Guido; Baréa, Christophe; Roussos, Constantinos; Stern, Richard; Hoffmeyer, Pierre

doi:10.2106/jbjs.i.00749

Cited by 32 publications

(16 citation statements)

References 36 publications

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“…Clinical evidence of the effect of BMI on revision rates is mixed. Some clinical studies have shown that BMI correlated with revision risk (Münger et al, 2006; Röder et al, 2008) others that it did not (Lübbeke et al, 2010). Ideally, we would have included donor activity level as an additional predictor but the data were not available.…”

Section: Discussionmentioning

confidence: 99%

Direct evidence of “damage accumulation” in cement mantles surrounding femoral hip stems retrieved at autopsy: Cement damage correlates with duration of use and BMI

Race

Miller

Izant

et al. 2011

Journal of Biomechanics

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The “damage accumulation” phenomenon has not been quantitatively demonstrated in clinical cement mantles surrounding femoral hip stems. We stained transverse sections of 11 postmortem retrieved femoral hip components fixed with cement using fluorescent dye-penetrant and quantified cement damage, voids, and cement-bone interface gaps in epifluorescence and white light micrographs. Crack density (Cr.Dn), crack length-density (Cr.Ln.Dn), porosity, and cement-bone interface gap fraction (c/b-gap%) were calculated, normalized by mantle area. Multiple regression tests showed that cement damage (Cr.Ln.Dn. & Cr.Dn.) was significantly positively correlated (r2=0.98, p<0.001) with “duration of use” and body mass index (“BMI”) but not cement mantle “porosity”. There were significant interactions: “duration of use”*”BMI” was strongly predictive (p<0.005) of Cr.Dn.; and “duration of use”*”porosity” was predictive (p=0.04) of Cr.Ln.Dn. Stem related cracks accounted for approximately one fifth of Cr.Dn and one third of Cr.Ln.Dn. The mean c/b-gap% was 13.8% but it did not correlate (r2=0.01, p=0.8) with duration of use. We concluded that duration-dependent fatigue damage accumulation occurred during in vivo use. BMI strongly influenced cement crack length and the rate of new crack formation over time. Voids did not increase the rate of crack initiation but appeared to have promoted crack growth over time. Although not progressive, substantial bone resorption at the cement-bone interface appeared to be common.

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Section: Discussionmentioning

confidence: 99%

Direct evidence of “damage accumulation” in cement mantles surrounding femoral hip stems retrieved at autopsy: Cement damage correlates with duration of use and BMI

Race

Miller

Izant

et al. 2011

Journal of Biomechanics

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“…However, the Workgroup of the American Association of Hip and Knee Surgeons Evidence-Based Committee determined from their literature review that all obese patients (ie, BMI .30) appear to be at risk for an increasing number of perioperative complications after total joint arthroplasty (TJA), especially with poorly controlled comorbidities. 27 Implant survival times also are similar, 28 although some clinicians reported significantly lower implant survival times in morbidly obese patients and more technical errors in obese patients. Dislocation also occurs more frequently after THA in obese patients.…”

Section: Total Joint Knee and Hip Arthroplastymentioning

confidence: 94%

Obesity, Orthopaedics, and Outcomes

Mihalko

Bergin

Kelly

et al. 2014

Journal of the American Academy of Orthopaedic Surgeons

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Obesity, one of the most common health conditions, affects an ever-increasing percentage of orthopaedic patients. Obesity is also associated with other medical conditions, including diabetes, cardiovascular disease, pulmonary disease, metabolic syndrome, and obstructive sleep apnea. These comorbidities require specific preoperative and postoperative measures to improve outcomes in this patient population. Patients who are obese are at risk for increased perioperative complications; however, orthopaedic procedures may still offer notable pain relief and improved quality of life.

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“…Obesity is associated with a higher incidence of perioperative complications including cardiovascular and respiratory events 42 , venous thrombosis 43 , wound infection 44 , and dislocation 45 . However, despite the increase in joint load in these patients, no consistent increase in bearing wear or osteolysis has been shown across study populations 46,47 and thus obesity is not a clear risk factor for osteolysis.…”

Section: Body Mass Index and Obesitymentioning

confidence: 68%

Risk Factors for Aseptic Loosening Following Total Hip Arthroplasty

MacInnes¹,

Gordon²,

Wilkinson³

2012

Recent Advances in Arthroplasty

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Influence of Obesity on Femoral Osteolysis Five and Ten Years Following Total Hip Arthroplasty

Abstract: Prognostic Level I. See Instructions to Authors for a complete description of levels of evidence.

Cited by 32 publications

References 36 publications

Direct evidence of “damage accumulation” in cement mantles surrounding femoral hip stems retrieved at autopsy: Cement damage correlates with duration of use and BMI

Direct evidence of “damage accumulation” in cement mantles surrounding femoral hip stems retrieved at autopsy: Cement damage correlates with duration of use and BMI

Obesity, Orthopaedics, and Outcomes

Risk Factors for Aseptic Loosening Following Total Hip Arthroplasty

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