Outcomes and complications of total hip replacement in super-obese patients

Abstract

The purpose of this study was to examine the complications and outcomes of total hip replacement (THR) in super-obese patients (body mass index (BMI) > 50 kg/m(2)) compared with class I obese (BMI 30 to 34.9 kg/m(2)) and normal-weight patients (BMI 18.5 to 24.9 kg/m(2)), as defined by the World Health Organization. A total of 39 THRs were performed in 30 super-obese patients with a mean age of 53 years (31 to 72), who were followed for a mean of 4.2 years (2.0 to 11.7). This group was matched with two cohorts of normal-weight and class I obese patients, each comprising 39 THRs in 39 patients. Statistical analysis was performed to determine differences among these groups with respect to complications and satisfaction based on the Western Ontario and McMaster Universities (WOMAC) osteoarthritis index, the Harris hip score (HHS) and the Short-Form (SF)-12 questionnaire. Super-obese patients experienced significantly longer hospital stays and higher rates of major complications and readmissions than normal-weight and class I obese patients. Although super-obese patients demonstrated reduced pre-operative and post-operative satisfaction scores, there was no significant difference in improvement, or change in the score, with respect to HHS or the WOMAC osteoarthritis index. Super-obese patients obtain similar satisfaction outcomes as class I obese and normal-weight patients with respect to improvement in their scores. However, they experience a significant increase in length of hospital stay and major complication and readmission rates.

What preoperative patient-related factors predict inpatient recovery of physical functioning and length of stay after total hip arthroplasty? A systematic review

“…surgical techniques, pain management, and postoperative mobilization protocols). 19,23,24,[26][27][28] Twelve studies investigated the predictive value of preoperative factors on the length of hospital stay, and two studies investigated the predictive value of preoperative factors on inpatient recovery of functioning. Recovery of functioning was assessed with the Modified Barthel Index (MBI) (an observational scale) 19 and with the patients' performance of ambulation distance.…”

“…After assessment of bias 13 out of 14 studies were classified as low risk. [19][20][21][22][23][24][25][26][27][29][30][31][32] …”

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

“…However, morbid obesity is associated with a higher risk of postoperative complications [6,21,24]. In addition, super obesity (BMI C 50 kg/m 2 ) has been reported to pose an even more substantial risk compared with the risk in patients who are less obese (BMI \ 50 kg/m 2 ) [8,15,23]. However, few peer-reviewed studies have addressed the surgical dilemma regarding whether to perform THA on patients who are morbidly obese or super obese [2,6,16,23].…”

“…Previous studies of complications in patients who are super obese were done in single institutions and focused on surgical complications rather than patient complications or costs involved [2,23,25]. However, to our knowledge, a nationwide study has not been performed on risks and costs when stratified by the degree of obesity, as measured by BMI.…”

Hip osteoarthritis surgical profiles and morbid obesity: a case series and literature review

“…Patients should be aware of their increased risk for post-surgical complications after total hip arthroplasty if they are obese Rajgopalet al [37] Examined the complications and outcomes of total hip replacement (THR) in super-obese patients (body mass index (BMI) > 50 kg/m(2)) compared with class I obese (BMI 30 to 34.9 kg/m(2)) and normal-weight patients (BMI 18.5 to 24.9 kg/m(2)), as defined by the World Health Organization.…”