Bariatric Orthopaedics: Total Hip Arthroplasty in Super-Obese Patients (Those with a BMI of >50 kg/m2)”

The increasing body weights of the patients and the growing responsibility to avoid postoperative adverse events have put a new urgency into expanding our knowledge of the impact of comorbidities such as obesity on our patients and health-care system.

Issa et al. presented a retrospective review of forty-five patients (forty-eight hips) with a minimum BMI of 50 kg/m2 who underwent Total Hip Arthroplasty at one of four high-volume joint centers.They compared implant survival, complication rates, Harris hip scores, Short Form-36 (SF-36) scores, and University of California Los Angeles (UCLA) activity scores with a matched control group of patients with a BMI of <30 kg/m2. Patients were followed for four to twelve years, which further contributes to the previous study by Issa et al. on super-obese patients undergoing Total Hip Arthroplasty followed for three years.

In the current study, Issa et al. reported an 8.2% lower implant survival rate in the super-obese patients at a mean time of six years and a 4.5% rate of septic revision. Compared with the non-obese patients, super-obese patients had inferior clinical results, as demonstrated by significantly lower postoperative scores. Issa et al. pointed out that the study was retrospective, although much of the data was accumulated prospectively.

Conclusion:

The clinical and patient-reported outcomes of primary Total Hip Arthroplasty were lower in the super-obese patients. These patients also faced challenges in finding surgeons who would perform their procedure. Super-obese patients may benefit from counseling with their treating surgeon to set realistic expectations with regard to the outcomes of their procedure.

Source:

Kimona Issa, MD; Steven F. Harwin, MD; Arthur L. Malkani, MD; Peter M. Bonutti, MD; Anthony Scillia, MD; Michael A. Mont, MD J Bone Joint Surg Am, 2016 Feb 03; 98 (3): 180 -185 . http://dx.doi.org/10.2106/JBJS.O.00474