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The Journal of Hip Surgery 2017; 01(03): 125-130
DOI: 10.1055/s-0037-1605385
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Total Hip Arthroplasty in Overweight Patients: Do Obesity and BMI Affect Implant Positioning, Outcomes, and Complications?

Michele F. Surace
1   Interdisciplinary Research Center for Pathology and Surgery of the Musculoskeletal System, Department of Biotechnology and Life Sciences, University of Insubria–DBSV, Varese, Italy
,
Luca Monestier
2   Department of Orthopedics and Trauma Surgery, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
,
Marco Calvi
3   Medical School, University of Insubria, Varese, Italy
,
Ettore Vulcano
4   Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York
,
Mario Cherubino
1   Interdisciplinary Research Center for Pathology and Surgery of the Musculoskeletal System, Department of Biotechnology and Life Sciences, University of Insubria–DBSV, Varese, Italy
,
Steven F. Harwin
5   Adult Reconstruction Service (SFH), Mount Sinai Beth Israel, New York
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Publikationsverlauf

22. Mai 2017

03. Juli 2017

Publikationsdatum:
24. August 2017 (online)

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Abstract

Obesity is one of the most problematic issues for health organizations worldwide because of its relationship with several chronic diseases. It is also demonstrated to increase early onset of hip arthritis, consequently leading to early failure of implants of total hip arthroplasty (THA). The aim of the study was to assess the influence of obesity on the positioning of prosthetic components and potential complications. A total of 312 patients underwent THA from 2006 to 2015 at our institute. All procedures were performed by a single surgeon (M.F.S.). As indicated by the World Health Organization (WHO), our population was stratified on the basis of body mass index (BMI): Four underweight, 112 nonobese, 131 overweight, 51 grade-1 obese, 10 grade-2 obese, and 4 grade-3 obese patients were included. No superobese patients were reported. The population was assessed clinically (implant survival, surgery time, blood loss, and complications) as well as radiologically (femoral offset, cup abduction and anteversion, and periacetabular osteolysis). Higher cup inclination (48.70 vs. 45.94 degrees), surgical time (86 vs. 80 min), and total blood losses (1,026 vs. 761 mL) were reported in overweight/obese patients (p < 0.01). Statistical analysis documented a significant relationship between obesity and cup inclination, surgical time, intraoperative and total blood losses, as well as BMI and age at surgery (p < 0.05). The overall correct positioning of prosthetic components is not significantly related to obesity. Although maintained in the “safe zone,” cup abduction, blood loss, and operative time tend to significantly increase with BMI.

Keywords

total hip arthroplasty - obese - BMI
 

  • References

  • 1 Ng M, Fleming T, Robinson M. , et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014; 384 (9945): 766-781
    CrossrefPubMedGoogle Scholar
  • 2 WHO Consultation on Obesity (1999: Geneva, Switzerland). Obesity: preventing and managing the global epidemic: report of a WHO consultation. WHO technical report series; 894
    PubMedGoogle Scholar
  • 3 Workgroup of the American Association of Hip and Knee Surgeons Evidence Based Committee. Obesity and total joint arthroplasty: a literature based review. J Arthroplasty 2013; 28 (05) 714-721
    CrossrefPubMedGoogle Scholar
  • 4 Fehring TK, Odum SM, Griffin WL, Mason JB, McCoy TH. The obesity epidemic: its effect on total joint arthroplasty. J Arthroplasty 2007; 22 (06) (Suppl. 02) 71-76
    CrossrefPubMedGoogle Scholar
  • 5 Bourne R, Mukhi S, Zhu N, Keresteci M, Marin M. Role of obesity on the risk for total hip or knee arthroplasty. Clin Orthop Relat Res 2007; 465 (465) 185-188
    CrossrefPubMedGoogle Scholar
  • 6 Liu B, Balkwill A, Banks E, Cooper C, Green J, Beral V. Relationship of height, weight and body mass index to the risk of hip and knee replacements in middle-aged women. Rheumatology (Oxford) 2007; 46 (05) 861-867
    CrossrefPubMedGoogle Scholar
  • 7 Murgatroyd SE, Frampton CMA, Wright MS. The effect of body mass index on outcome in total hip arthroplasty: early analysis from the New Zealand Joint Registry. J Arthroplasty 2014; 29 (10) 1884-1888
    CrossrefPubMedGoogle Scholar
  • 8 Moran M, Walmsley P, Gray A, Brenkel IJ. Does body mass index affect the early outcome of primary total hip arthroplasty?. J Arthroplasty 2005; 20 (07) 866-869
    CrossrefPubMedGoogle Scholar
  • 9 Yeung E, Jackson M, Sexton S, Walter W, Zicat B, Walter W. The effect of obesity on the outcome of hip and knee arthroplasty. Int Orthop 2011; 35 (06) 929-934
    CrossrefPubMedGoogle Scholar
  • 10 McLaughlin JR, Lee KR. The outcome of total hip replacement in obese and non-obese patients at 10- to 18-years. J Bone Joint Surg Br 2006; 88 (10) 1286-1292
    PubMedGoogle Scholar
  • 11 Michalka PK, Khan RJ, Scaddan MC, Haebich S, Chirodian N, Wimhurst JA. The influence of obesity on early outcomes in primary hip arthroplasty. J Arthroplasty 2012; 27 (03) 391-396
    CrossrefPubMedGoogle Scholar
  • 12 Andrew JG, Palan J, Kurup HV, Gibson P, Murray DW, Beard DJ. Obesity in total hip replacement. J Bone Joint Surg Br 2008; 90 (04) 424-429
    Google Scholar
  • 13 Stickles B, Phillips L, Brox WT, Owens B, Lanzer WL. Defining the relationship between obesity and total joint arthroplasty. Obes Res 2001; 9 (03) 219-223
    CrossrefPubMedGoogle Scholar
  • 14 Changulani M, Kalairajah Y, Peel T, Field RE. The relationship between obesity and the age at which hip and knee replacement is undertaken. J Bone Joint Surg Br 2008; 90 (03) 360-363
    CrossrefPubMedGoogle Scholar
  • 15 Haverkamp D, Klinkenbijl MN, Somford MP, Albers GH, van der Vis HM. Obesity in total hip arthroplasty--does it really matter? A meta-analysis. Acta Orthop 2011; 82 (04) 417-422
    CrossrefPubMedGoogle Scholar
  • 16 Lübbeke A, Stern R, Garavaglia G, Zurcher L, Hoffmeyer P. Differences in outcomes of obese women and men undergoing primary total hip arthroplasty. Arthritis Rheum 2007; 57 (02) 327-334
    CrossrefPubMedGoogle Scholar
  • 17 Ibrahim T, Hobson S, Beiri A, Esler CN. No influence of body mass index on early outcome following total hip arthroplasty. Int Orthop 2005; 29 (06) 359-361
    CrossrefPubMedGoogle Scholar
  • 18 Wagner ER, Kamath AF, Fruth KM, Harmsen WS, Berry DJ. Effect of body mass index on complications and reoperations after total hip arthroplasty. J Bone Joint Surg Am 2016; 98 (03) 169-179
    CrossrefPubMedGoogle Scholar
  • 19 Issa K, Harwin SF, Malkani AL, Bonutti PM, Scillia A, Mont MA. Bariatric orthopaedics: total hip arthroplasty in super-obese patients (those with a BMI of ≥50 kg/m2). J Bone Joint Surg Am 2016; 98 (03) 180-185
    CrossrefPubMedGoogle Scholar
  • 20 Surace MF, Monestier L, Vulcano E, Harwin SF, Cherubino P. Conventional versus cross-linked polyethylene for total hip arthroplasty. Orthopedics 2015; 38 (09) 556-561
    CrossrefPubMedGoogle Scholar
  • 21 Lewinnek GE, Lewis JL, Tarr R, Compere CL, Zimmerman JR. Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg Am 1978; 60 (02) 217-220
    CrossrefPubMedGoogle Scholar
  • 22 Lu M, Zhou YX, Du H, Zhang J, Liu J. Reliability and validity of measuring acetabular component orientation by plain anteroposterior radiographs. Clin Orthop Relat Res 2013; 471 (09) 2987-2994
    CrossrefPubMedGoogle Scholar
  • 23 Surace MF, Monestier L, Fagetti A, Ronga M, Cherubino P. Computer-based assessment and classification of periacetabular osteolytic lesions: a new method. Surg Technol Int 2012; 22: 285-289
    PubMedGoogle Scholar
  • 24 Chee YH, Teoh KH, Sabnis BM, Ballantyne JA, Brenkel IJ. Total hip replacement in morbidly obese patients with osteoarthritis: results of a prospectively matched study. J Bone Joint Surg Br 2010; 92 (08) 1066-1071
    PubMedGoogle Scholar
  • 25 Elson LC, Barr CJ, Chandran SE, Hansen VJ, Malchau H, Kwon YM. Are morbidly obese patients undergoing total hip arthroplasty at an increased risk for component malpositioning?. J Arthroplasty 2013; 28 (8, Suppl) 41-44
    CrossrefPubMedGoogle Scholar
  • 26 McArthur BA, Vulcano E, Cross M, Nguyen J, Della Valle AG, Salvati E. Acetabular component orientation in total hip arthroplasty: the impact of obesity. Hip Int 2014; 24 (03) 263-269
    CrossrefPubMedGoogle Scholar
  • 27 Todkar M. Obesity does not necessarily affect the accuracy of acetabular cup implantation in total hip replacement. Acta Orthop Belg 2008; 74 (02) 206-209
    PubMedGoogle Scholar