Total Hip Arthroplasty Outcomes in Morbidly Obese Patients: A Systematic Review

Overview

Journal EFORT Open Rev

Specialty Orthopedics

Date 2018 Oct 12

PMID 30305935

Citations 21

Authors

Matthew Barrett

Anoop Prasad

Louis Boyce

Sebastian Dawson-Bowling

Pramod Achan

Steven Millington

Sammy A Hanna

Affiliations

Soon will be listed here.

Abstract

The increasing prevalence of obesity has resulted in a marked increase in the number of total hip arthroplasties (THAs) carried out in patients with a high body mass index (BMI).THA in morbidly obese patients is often technically challenging owing to the associated co-morbidities and anatomical factors. Furthermore, the long-term clinical and functional outcomes of the procedure in these patients are not clear.The aim of this systematic review was to compare the long-term failure rate and functional outcomes of THA in morbidly obese versus non-obese patients.A literature search of PubMed, EMBASE and PubMed Central was conducted to identify studies that compared the outcomes of THA in patients defined as morbidly obese (BMI ≥ 35) to a control group (BMI < 30). The primary and secondary outcome measures were rate of revision and functional outcome, respectively, in the long term.Eight studies were included in this review. There were 66,238 THAs in morbidly obese patients and 705,619 THAs in patients with a BMI < 30. The overall revision rate was 7.99% in the morbidly obese patients versus 2.75% in the non-obese controls. The functional outcome was at least comparable to non-obese patients.This review suggests that morbidly obese patients have a slightly increased revision rate following THA. Importantly, these patients have a functional recovery at least comparable to those with a BMI < 30. Morbidly obese patients should be fully informed of these issues prior to undergoing surgery. Cite this article: 2018;3:507-512. DOI: 10.1302/2058-5241.3.180011.

Citing Articles

Subsidence and Clinical Impact of Obesity in Short-Stem Total Hip Arthroplasty Using a Collarless, Triple-Tapered, Cementless Stem.

Gruber M, Schoning J, Bischofreiter M, Kindermann H, Schulz A, Hinz N J Clin Med. 2025; 13(24.

PMID: 39768519 PMC: 11678452. DOI: 10.3390/jcm13247596.

Functional Recovery After Hip Arthroplasty with a Minimal Invasive or Classical Approach Eight Years After Intervention.

Vuckovic M, Ruzic L, Tudor K, Prpic T, Jotanovic Z, Segulja S J Funct Morphol Kinesiol. 2024; 9(4).

PMID: 39584861 PMC: 11587008. DOI: 10.3390/jfmk9040208.

Does Body Mass Index (BMI) Affect the Reconstruction of Biomechanical Parameters in Patients Undergoing Total Hip Replacement (THR) through the Direct Anterior Approach (DAA)?.

Weissenberger M, Heinz T, Rak D, Stratos I, Anderson P, Ludemann M J Clin Med. 2024; 13(2).

PMID: 38256601 PMC: 10816045. DOI: 10.3390/jcm13020467.

Short stem hip arthroplasty with the optimys prosthesis is a safe and effective option for obese patients: a mid-term follow-up multicenter study.

Hinz N, Marsoni G, Mittelstadt H, Sonnabend F, Wallroth K, Johl C Arch Orthop Trauma Surg. 2023; 144(3):1401-1414.

PMID: 37924371 PMC: 10896938. DOI: 10.1007/s00402-023-05105-4.

Body Mass Index (BMI) Cutoffs and Racial, Ethnic, Sex, or Age Disparities in Patients Treated With Total Ankle Arthroplasty.

Chao M, Manz W, Fink J, Coleman M, Kadakia R, Bariteau J Foot Ankle Orthop. 2023; 8(3):24730114231184189.

PMID: 37484537 PMC: 10359662. DOI: 10.1177/24730114231184189.

References

Marks R, Allegrante J . Body mass indices in patients with disabling hip osteoarthritis. Arthritis Res. 2002; 4(2):112-6. PMC: 83842. DOI: 10.1186/ar387. View

Sadr Azodi O, Adami J, Lindstrom D, Eriksson K, Wladis A, Bellocco R . High body mass index is associated with increased risk of implant dislocation following primary total hip replacement: 2,106 patients followed for up to 8 years. Acta Orthop. 2008; 79(1):141-7. DOI: 10.1080/17453670710014897. View

Ibrahim T, Hobson S, Beiri A, Esler C . No influence of body mass index on early outcome following total hip arthroplasty. Int Orthop. 2005; 29(6):359-61. PMC: 2231583. DOI: 10.1007/s00264-005-0012-8. View

Huschak G, Busch T, Kaisers U . Obesity in anesthesia and intensive care. Best Pract Res Clin Endocrinol Metab. 2013; 27(2):247-60. DOI: 10.1016/j.beem.2013.02.001. View

Moran M, Walmsley P, Gray A, Brenkel I . Does body mass index affect the early outcome of primary total hip arthroplasty?. J Arthroplasty. 2005; 20(7):866-9. DOI: 10.1016/j.arth.2005.02.008. View

Deurenberg P, Weststrate J, Seidell J . Body mass index as a measure of body fatness: age- and sex-specific prediction formulas. Br J Nutr. 1991; 65(2):105-14. DOI: 10.1079/bjn19910073. View

Fehring T, Odum S, Griffin W, Mason J, McCoy T . The obesity epidemic: its effect on total joint arthroplasty. J Arthroplasty. 2007; 22(6 Suppl 2):71-6. DOI: 10.1016/j.arth.2007.04.014. View

Harms S, Larson R, Sahmoun A, Beal J . Obesity increases the likelihood of total joint replacement surgery among younger adults. Int Orthop. 2006; 31(1):23-6. PMC: 2267551. DOI: 10.1007/s00264-006-0130-y. View

Lowe G, Haverkate F, Thompson S, Turner R, Bertina R, Turpie A . Prediction of deep vein thrombosis after elective hip replacement surgery by preoperative clinical and haemostatic variables: the ECAT DVT Study. European Concerted Action on Thrombosis. Thromb Haemost. 1999; 81(6):879-86. View

10.

Haverkamp D, Klinkenbijl M, Somford M, Rob Albers G, van der Vis H . Obesity in total hip arthroplasty--does it really matter? A meta-analysis. Acta Orthop. 2011; 82(4):417-22. PMC: 3237030. DOI: 10.3109/17453674.2011.588859. View

11.

. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser. 2001; 894:i-xii, 1-253. View

12.

Rajgopal R, Martin R, Howard J, Somerville L, MacDonald S, Bourne R . Outcomes and complications of total hip replacement in super-obese patients. Bone Joint J. 2013; 95-B(6):758-63. DOI: 10.1302/0301-620X.95B6.31438. View

13.

Liu W, Wahafu T, Cheng M, Cheng T, Zhang Y, Zhang X . The influence of obesity on primary total hip arthroplasty outcomes: A meta-analysis of prospective cohort studies. Orthop Traumatol Surg Res. 2015; 101(3):289-96. DOI: 10.1016/j.otsr.2015.01.011. View

14.

Sturm R . Increases in clinically severe obesity in the United States, 1986-2000. Arch Intern Med. 2003; 163(18):2146-8. DOI: 10.1001/archinte.163.18.2146. View

15.

Werner B, Higgins M, Pehlivan H, Carothers J, Browne J . Super Obesity Is an Independent Risk Factor for Complications After Primary Total Hip Arthroplasty. J Arthroplasty. 2016; 32(2):402-406. DOI: 10.1016/j.arth.2016.08.001. View

16.

Lehman D, Capello W, Feinberg J . Total hip arthroplasty without cement in obese patients. A minimum two-year clinical and radiographic follow-up study. J Bone Joint Surg Am. 1994; 76(6):854-62. DOI: 10.2106/00004623-199406000-00009. View

17.

Jackson M, Sexton S, Yeung E, Walter W, Walter W, Zicat B . The effect of obesity on the mid-term survival and clinical outcome of cementless total hip replacement. J Bone Joint Surg Br. 2009; 91(10):1296-300. DOI: 10.1302/0301-620X.91B10.22544. View

18.

Andrew J, Palan J, Kurup H, Gibson P, Murray D, Beard D . Obesity in total hip replacement. J Bone Joint Surg Br. 2008; 90(4):424-9. DOI: 10.1302/0301-620X.90B4.20522. View

19.

McCalden R, Charron K, MacDonald S, Bourne R, Naudie D . Does morbid obesity affect the outcome of total hip replacement?: an analysis of 3290 THRs. J Bone Joint Surg Br. 2011; 93(3):321-5. DOI: 10.1302/0301-620X.93B3.25876. View

20.

Chee Y, Teoh K, Sabnis B, Ballantyne J, Brenkel I . Total hip replacement in morbidly obese patients with osteoarthritis: results of a prospectively matched study. J Bone Joint Surg Br. 2010; 92(8):1066-71. DOI: 10.1302/0301-620X.92B8.22764. View