Total Hip Arthroplasty Does not Aid Weight Loss

Abstract

Ann R Coll Surg Engl 2007; 89: 288-291 288Overweight patients awaiting total hip arthroplasty are often encouraged to lose weight pre-operatively in order to reduce the risk of peri-operative complications.1 High body mass index (BMI) has been shown to be a risk factor associated with development of osteoarthritis of the hip. 2Many of these patients cite restricted mobility and pain as impeding factors in their attempts to lose weight. There is often an assumption by the patient that weight loss will occur after their surgery once their mobility has returned.This study investigates the effect of total hip arthroplasty (THA) on patient BMI. We hypothesise that neither weight loss, nor reduction in BMI can be assumed following hip arthroplasty surgery. Patients and MethodsThe records of patients who had undergone elective THA surgery in a district general hospital located in the south east of England between 2002 and 2004 were retrospectively analysed. The weight and height of each patient prior to surgery and 2 years after surgery, whilst attending follow-up clinic, was recorded. The BMI of each patient pre-operatively and 2 years postoperatively was calculated by dividing body weight (kg) by the square of the patient's height (m). For analysis, patients were stratified by pre-operative BMI into those with a BMI of 20-24.9 kg/m 2 (acceptable weight), 25-29.9 kg/m 2 (overweight) and of those 30 kg/m 2 and greater (obese). 6 Statistical analysisEach patient's BMI recorded pre-operatively was compared with that recorded 2 years postoperatively using the paired Student's t-test. Analysis of the data was conducted stratifying by patient sex and pre-operative BMI. ResultsThe records of 180 patients (72 male and 108 female) were identified and analysed. Mean age at time of surgery was 65 years (range, 26-86 years). Analysis showed that when patients were stratified by their pre-operative BMI, there was a statistically significant increase in BMI measured 2 years postoperatively compared to BMI measured prior to surgery, irrespective of preoperative body mass index (Fig. 1). Mean BMI increased from 29.05 kg/m 2 by 1.05 kg/m 2 (P < 0.001) over the 2-year period, equating to an average increase in weight of 2.5 kg or an increase in BMI of 3.6%. There is an assumption that weight loss will occur after their surgery due to increased mobility.

Dual-mobility or Constrained Liners Are More Effective Than Preoperative Bariatric Surgery in Prevention of THA Dislocation

“…This is in concordance with our study that demonstrates that the effect of obesity on dislocation may be underestimated without adjustment for hip and thigh circumference. Our findings also confirm [9,27,29] that patients with obesity undergoing primary THA are at risk for weight gain and not for weight loss even if they are pain-free after surgery. Patients and surgeons should be made aware that weight gain risk begins within the first year and persists for at least 5 years after surgery and that the cumulative risk of dislocation increases with time.…”

Do Patients Lose Weight After Joint Arthroplasty Surgery? A Systematic Review

“…Of the 12 studies [1, 2, 10-12, 17, 18, 22, 26, 34, 36, 37], one was a case-cohort study [37] and the other 11 were case series, with the majority from series of single surgeons (n = 2) [17,22] or single hospitals (n = 6) [11,12,18,26,34,37]. Four studies did not mention the setting or number of surgeons participating in the study [1,2,10,36].…”

“…Studies with stricter inclusion criteria focused on one type of procedure (primary TJA), for osteoarthritis, and excluded bilateral procedures. However, two studies did not provide any information on these three main eligibility criteria (diagnosis, procedure type, bilaterality) [26,36]. Of the remaining studies, three did not specify whether bilateral procedures were included in their sample [1,17,34] and two did not specify the types of procedures included [1,10].…”

“…Of the remaining studies, three did not specify whether bilateral procedures were included in their sample [1,17,34] and two did not specify the types of procedures included [1,10]. When using these three eligibility criteria, five studies were considered at high risk of selection bias [1,17,34,36,37], one was moderate risk [22], three were low risk [11,12,18], and the risk could not be evaluated in the three remaining studies [2,10,26].…”

“…All studies specified that joint arthroplasty was performed (TJA, TKA, and/or THA); however, inclusion of procedures other than primary TJA could not be determined in four studies [1,10,26,36]. All studies were categorized as being low risk of possible detection bias as they included patients with joint arthroplasties.…”