Weight gain and the risk of total hip replacement a population-based prospective cohort study of 265,725 individuals

Objective Literature examining the effects of total hip arthroplasty (THA) on subsequent body weight gain is inconclusive. Determining the extent to which clinically relevant weight gain occurs following THA has important public health implications. Design We used multivariable logistic regression to compare data from one of the largest US-based THA registries to a population-based control sample from the same geographic region. We also identified factors that increased risk of clinically important weight gain specifically among persons undergoing THA. The outcome measure of interest was weight gain of ≥ 5% of body weight up to 5 years following surgery. Results The multivariable adjusted (age, sex, BMI, education, comorbidity and pre-surgical weight change) odds ratio for important weight gain was 1.7 (95% CI, 1.06, 2.6) for a person with THA as compared the control sample. Additional arthroplasty procedures during the 5-year follow-up further increased odds for important weight gain (OR=2.0, 95% CI, 1.4, 2.7) relative to the control sample. A patient with THA had increased risk of important post-surgical weight gain of 12% (OR=1.12; 95%CI,1.08, 1.16) for every kilogram of pre-operative weight loss. Conclusions While findings should be interpreted with caution because of missing follow-up weight data, patients with THA appear to be at increased risk of clinically important weight gain following surgery as compared to peers. Patients less than 60 years and who have lost a substantial amount of weight prior to surgery appear to be at particularly high risk of important postsurgical weight gain.

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“…Weight gain following surgery is particularly important for women who are at increased risk of future hip arthroplasty due to weight gain. 47 …”

Section: Discussionmentioning

confidence: 99%

Clinically important body weight gain following total hip arthroplasty: a cohort study with 5-year follow-up

Riddle

Singh

Harmsen

et al. 2013

Osteoarthritis and Cartilage

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“…Compared with normalweight individuals, obese patients incur 46% higher inpatient costs and 27% more physician visits and outpatient costs [12]. Obesity is also associated with greater likelihood of osteoarthritis thus requiring THA [2]. Indisputably, more obese patients are undergoing THA today than 10 to 20 years ago [11].…”

Section: Introductionmentioning

confidence: 99%

Obesity Increases Length of Stay and Direct Medical Costs in Total Hip Arthroplasty

Kremers

Visscher

Kremers

et al. 2014

Clinical Orthopaedics &Amp; Related Research

124

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Background The number of obese patients undergoing THA is increasing. Previous studies have shown that obesity is associated with an increased likelihood of complications after THA, but there is little information regarding the impact of obesity on medical resource use and direct medical costs in THA. Questions/purposes We sought to examine the relationship between obesity, length of stay, and direct medical costs in a large cohort of patients undergoing THAs. Methods The study included 8973 patients who had undergone 6410 primary and 2563 revision THAs at a large US medical center between January 1, 2000, and September 31, 2008. Patients with bilateral procedures within 90 days after index admission and patients with acute trauma were excluded. Data regarding clinical, surgical characteristics, and complications were obtained from the original medical records and the institutional joint registry. Patients were classified into eight groups based on their BMI at the time of surgery. Direct medical costs were calculated by using standardized, inflation-adjusted costs for services and procedures billed during hospitalization and the 90-day window. Study end points were hospital length of stay, direct medical costs during hospitalization, and the 90-day window. End points were compared across the eight BMI categories in multivariable risk-adjusted linear regression models. Results Mean length of stay and the direct medical costs were lowest for patients with a BMI of 25 to 35 kg/m 2 . Increasing BMI was associated with longer hospital stays and costs. Every five-unit increase in BMI beyond 30 kg/ m 2 was associated with approximately USD $500 higher hospital costs and USD $900 higher 90-day costs in primary THA (p = 0.0001), which corresponded to 5% higher costs. The cost increase associated with BMI was

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“…Younger adults (<20 years) are at greater risk compared with older individuals (>30 years). 4 In a large prospective populationbased cohort from Iceland the incidence of clinically severe osteoarthritis (as indicated by arthroplasty), in relation to measures of overweight, found that 36% and 50% of those with hip and knee osteoarthritis, respectively, had a BMI greater than 30. 5 This is compared with a national prevalence of 17% of the adult population (the International Obesity Task force, http://www.iotf.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the genetic overlap between osteoarthritis with body mass index and height using genome-wide association scan data

Elliott¹,

Chapman

Day‐Williams

et al. 2012

Ann Rheum Dis

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ObjectivesObesity as measured by body mass index (BMI) is one of the major risk factors for osteoarthritis. In addition, genetic overlap has been reported between osteoarthritis and normal adult height variation. We investigated whether this relationship is due to a shared genetic aetiology on a genome-wide scale.MethodsWe compared genetic association summary statistics (effect size, p value) for BMI and height from the GIANT consortium genome-wide association study (GWAS) with genetic association summary statistics from the arcOGEN consortium osteoarthritis GWAS. Significance was evaluated by permutation. Replication of osteoarthritis association of the highlighted signals was investigated in an independent dataset. Phenotypic information of height and BMI was accounted for in a separate analysis using osteoarthritis-free controls.ResultsWe found significant overlap between osteoarthritis and height (p=3.3×10−5 for signals with p≤0.05) when the GIANT and arcOGEN GWAS were compared. For signals with p≤0.001 we found 17 shared signals between osteoarthritis and height and four between osteoarthritis and BMI. However, only one of the height or BMI signals that had shown evidence of association with osteoarthritis in the arcOGEN GWAS was also associated with osteoarthritis in the independent dataset: rs12149832, within the FTO gene (combined p=2.3×10−5). As expected, this signal was attenuated when we adjusted for BMI.ConclusionsWe found a significant excess of shared signals between both osteoarthritis and height and osteoarthritis and BMI, suggestive of a common genetic aetiology. However, only one signal showed association with osteoarthritis when followed up in a new dataset.

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Weight gain and the risk of total hip replacement a population-based prospective cohort study of 265,725 individuals

Cited by 32 publications

References 36 publications

Clinically important body weight gain following total hip arthroplasty: a cohort study with 5-year follow-up

Clinically important body weight gain following total hip arthroplasty: a cohort study with 5-year follow-up

Obesity Increases Length of Stay and Direct Medical Costs in Total Hip Arthroplasty

Evaluation of the genetic overlap between osteoarthritis with body mass index and height using genome-wide association scan data

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