Total hip arthroplasty in obesity: separating ‘fat’ from fiction

Abstract

Obesity is a modern-day epidemic with increasing prevalence that is directly impacting the global burden of primary total hip arthroplasty. The risk of requiring total hip arthroplasty for osteoarthritis increases incrementally with increasing obesity class. Surgical intervention in obese patients presents a set of unique challenges that should be recognized by the treating medical team. Although predominantly satisfactory outcomes have been reported, perioperative anaesthetic and surgical concerns require thorough patient assessment. There is an increased potential risk of thrombogenic and septic complications, but the body mass index cutoff level beyond which total hip arthroplasty should not be offered in the obese patient remains controversial. Preoperative medical optimization of the patient and appropriate intraoperative interventions are essential to mitigate the risk of complications.

The Association of Body Mass Index with Surgical Time Is Mediated by Comorbidity in Patients Undergoing Total Hip Arthroplasty

“…THA is considered the gold standard in the treatment of end-stage hip OA. Compared to non-obese patients, overweight and obese individuals undergoing THA are usually younger and present a higher risk of perioperative complications [ 53 ]. Indeed, obesity is a multisystemic disease often accompanied by several comorbidities that may increase the likelihood of intra- or post-procedural adverse events [ 54 ].…”

“…Similarly, while being convenient to the surgeon to reduce bleeding, intraoperative hypotension should be avoided in patients with a previous ischemic stroke due to the higher risk of cerebral hypoperfusion and recurrent ischemic events [ 60 ]. In addition, intraprocedural issues concerning airway management and alterations of vital signs in this subset of patients may occasionally require the surgeon to stop operating until the situation is under control [ 53 ].…”

The Influence of Abdominal Obesity on Hip Pain, Function, and Walking Ability after Three Years of THA: A Prospective Cohort Study

“…However, there has been controversy over whether obesity has impact on THA. We reviewed many works of literature on the effects of obesity on THA, the conclusions of which are not uniform or even contradictory, holding opposite views [2][3][4][5][6][7].…”

Obesity in Total Hip Arthroplasty: Demographic Disparities and Outcome Incongruities

“…Obesity is undoubtedly a lifestyle disease; yet, there is ample evidence that social determinants of health are key risk factors that may inhibit patients from losing weight before surgery. For instance, people without college educations are twice as likely to be obese than their college educated counterparts [7]. Additionally, lower socioeconomic status is associated with higher rates of obesity.…”

“…Additionally, lower socioeconomic status is associated with higher rates of obesity. Interestingly, one study found that simply moving out of a highly impoverished neighborhood significantly reduced the odds of developing this disease [7]. Finally, ethnicity is associated with obesity, as African American and Hispanic communities face disproportionately higher rates of obesity than non-Hispanic Caucasians [8,9].…”