Outcomes of morbidly obese patients undergoing total hip arthroplasty with the anterior-based muscle-sparing approach

Abstract

AimsObesity is associated with an increased risk of hip osteoarthritis, resulting in an increased number of total hip arthroplasties (THAs) performed annually. This study examines the peri- and postoperative outcomes of morbidly obese (MO) patients (BMI ≥ 40 kg/m2) compared to healthy weight (HW) patients (BMI 18.5 to < 25 kg/m2) who underwent a THA using the anterior-based muscle-sparing (ABMS) approach.MethodsThis retrospective cohort study observes peri- and postoperative outcomes of MO and HW patients who underwent a primary, unilateral THA with the ABMS approach. Data from surgeries performed by three surgeons at a single institution was collected from January 2013 to August 2020 and analyzed using Microsoft Excel and Stata 17.0.ResultsThis study compares 341 MO to 1,140 HW patients. Anaesthesia, surgery duration, and length of hospital stay was significantly lower in HW patients compared to MO. There was no difference in incidence of pulmonary embolism, periprosthetic fracture, or dislocation between the two groups. The rate of infection in MO patients (1.47%) was significantly higher than HW patients (0.14%). Preoperative patient-reported outcome measures (PROMs) show a significantly higher pain level in MO patients and a significantly lower score in functional abilities. Overall, six-week and one-year postoperative data show higher levels of pain, lower levels of functional improvement, and lower satisfaction scores in the MO group.ConclusionThe comorbidities of obesity are well studied; however, the implications of THA using the ABMS approach have not been studied. Our peri- and postoperative results demonstrate significant improvements in PROMs in MO patients undergoing THA. However, the incidence of deep infection was significantly higher in this group compared with HW patients.Cite this article: Bone Jt Open 2023;4(5):299–305.

Patient satisfaction and patient-reported outcomes do not vary by BMI class in total hip arthroplasty

“…We acknowledge the need to consider surgical risks as an important factor in preoperative evaluation. Reports in the literature provide more consistent results suggesting increased postoperative complications such as infection, readmission, and reoperation in obese patients [ 6 , 7 , 21 ]. These complications, however, are outside the scope of the current study as our objective was to compare pain, function, and satisfaction as a function of BMI classification.…”

“…Finally, studies also report that patients with greater BMI have worse pain and function outcomes after THA. Shevenell et al [ 6 ] reported that patients with Class III obesity were found to have greater pain ( p = 0.041) and worse functional improvement (measured by HOOS JR, p = 0.002) 1 year after THA compared to healthy weight individuals. Our results demonstrate greater subjective functional improvements and pain reduction in higher obesity classes, which contrast with this previous report.…”

“…Furthermore, many studies examine PROMs at various postoperative intervals, and the different methods can again lead to different results. Also, the BMI classifications that studies use to compare PROMs differ within the literature, with some studies comparing only morbidly obese patients (BMI ≥ 40) to healthy weight patients [ 6 ] or only obese patient (BMI ≥ 35) to healthy weight patients [ 23 ], while others use the World Health Organization BMI classifications [ 3 ]. Finally, while many studies report statistically significant differences in PROMs between BMI classes, it is important to recognize that some statistically significant findings are not clinically significant.…”

“…Although there is evidence demonstrating increased rates of postoperative complications in obese patients undergoing THA [6,7], studies investigating the impact of patients' body mass index (BMI) on functional outcomes provide conflicting results. For example, Shevenell et al [6] reports greater pain and less functional improvement among morbidly obese patients 1 year after THA when compared to healthy weight individuals, whereas Robertson et al [3] reports no differences in absolute or change in patient reported outcome measures (PROMs) between any weight category for patients undergoing THA. These studies are not alone in their conflicting results [8][9][10][11].…”

The Impact of Obesity on the Health of the Older Population: A Cross-Sectional Study on the Relationship between Health-Related Quality of Life and Body Mass Index across Different Age Groups

“…Moreover, it has been demonstrated that the beneficial effects of dietary fibers on the intestines may be diminished in obese children with pre-existing insulin resistance [ 18 ]. Furthermore, individuals classified as obese based on BMI classification face an increased risk of postoperative complications, as evident in hip arthroplasty [ 19 , 20 ]. In such cases, they are more susceptible to deep infections and femoral stem subsidence compared to normal-weight individuals.…”