Relationship between Body Mass Index and Complications during the First 45 Days after Primary Total Hip and Knee Replacement: A Single-Center Study from South America

Abstract

Background The goal of this study was to evaluate the relationship between body mass index (BMI) and early complications of total hip replacement (THR) and total knee replacement (TKR). Methods This is a retrospective study of patients who underwent primary THR and TKR between January 2011 and December 2015. We included patients between 18 and 90 years of age with BMI less than 40 kg/m 2 with a minimal postoperative follow-up time of 45 days. The primary outcomes were the presence of infection, mechanical complications (dislocation, fractures, arthrofibrosis, or neuropraxia), and thromboembolic events. Overweight and obesity were defined as a BMI of 25–29.9 kg/m 2 and ≥ 30 kg/m 2 , respectively. Results In total 750 patients were included (THR, 268; TKR, 482) with a mean age of 65.0 ± 12.4 years. The percentage of patients with normal weight, overweight, and obesity was 24.9% (n = 187), 41.7% (n = 313), and 33.4% (n = 250), respectively. The early complication rate was 8.9% (95% confidence interval [CI], 7.1% to 11.2%). Infection and mechanical complications were most prevalent. There was no statistically significant relationship between the incidence of complications and BMI (obesity vs. normal weight: hazard ratio [HR], 1.49; 95% CI, 0.72 to 3.06; p = 0.282); however, there was a tendency toward a greater risk of infectious complications in the patients with obesity (HR, 6.08; 95% CI, 0.75 to 49.16; p = 0.090). Patients with diabetes mellitus (DM) had more risk of infectious complications than those without DM (HR, 2.60; 95% CI, 1.00 to 6.79). Conclusions There was no statistical relationship between BMI and early complications of THR and TKR. Nonetheless, there was a tendency toward a higher risk of infection in patients with some degree of obesity.

The effect of body mass index on blood loss and complications in simultaneous bilateral total hip arthroplasty: A multicenter retrospective study

“…However, more and more studies supported that BMI alone was not an independent risk factor for a higher complication rate and obesity could not lead to higher risk of complications . [29][30][31] In the long term, after the analysis of nationwide billing data in Germany, Jeschke et al 32 showed that elevated BMI could increase the risk of remotely 90 day complications and 1 year revision rates . Notably, above papers reached a consensus, which was that the complication risk will dramatically increase when the BMI was more than 40 kg/m 2 .…”

Increased rate of complications in myasthenia gravis patients following hip and knee arthroplasty: a nationwide database study in the PearlDiver Database on 257,707 patients

“… 2019 , Correa-Valderrama et al. 2019 ). For TKA, male patients have higher rates of revision surgery, mortality, hospital readmission, and wound infections compared with women, while female patients have increased risk of readmission, reoperation, and wound infection following THA (Singh et al.…”

“…In terms of in-hospital complications, examples of such poor outcomes include acute myocardial infarction, DVT or PE, surgical site infection, sepsis, hemorrhage, and mortality (Fang et al 2015). Similarly, patients with a BMI classification of ≥ 30 are more likely to experience prosthetic failure and postoperative infection following TKA and THA (Boyce et al 2019, Correa-Valderrama et al 2019. For TKA, male patients have higher rates of revision surgery, mortality, hospital readmission, and wound infections compared with women, while female patients have increased risk of readmission, reoperation, and wound infection following THA (Singh et al 2013, Patel et al 2020.…”

Current Incidence and Future Projection of Periprosthetic Fractures in South Korea: A Study Based on National Claim Database

“…Not only do these PFs normally require surgery, but the difficulty of the required surgeries is a challenge to orthopaedic surgeons 10 . Arthroplasty surgeons have made various efforts to prevent the PFs during the primary arthroplasty and evaluate the risks of PFs in the follow-up [11][12][13] . It has been suggested that age, gender, use of corticosteroids, poor bone quality, number of previous surgeries, stiff joints, neurological comorbidities, inflammatory arthropathy, and type of implants used in primary arthroplasties could increase the risk of PFs 2,4,6,[14][15][16][17] .…”