Greater risks of complications, infections, and revisions in the obese versus non-obese total hip arthroplasty population of 2,190,824 patients: a meta-analysis and systematic review

Onggo, James Randolph; Onggo, Jason Derry; Steiger, Richard de; Hau, Raphael

doi:10.1016/j.joca.2019.10.005

Cited by 50 publications

(41 citation statements)

References 75 publications

(38 reference statements)

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“…Severe obesity is widely associated with reduced cardiopulmonary capacity, metabolic abnormalities and decreased haemostasis, which may predispose patients to morbidity and mortality after surgery. 14 These factors might lead to a higher threshold for orthopaedic surgeon to progress to surgery.…”

Section: Discussionmentioning

confidence: 99%

Which patients improve most after total hip arthroplasty? Influence of patient characteristics on patient-reported outcome measures of 22,357 total hip arthroplasties in the Dutch Arthroplasty Register

et al. 2020

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Background: Patient-reported outcome measures (PROMs) after total hip arthroplasty (THA), can be influenced by patient characteristics (case-mix factors). We used the Dutch Arthroplasty Register (LROI) to determine the effect of case-mix on improvement of PROMs after primary THA. Methods: We included all primary THAs ( n = 22,357) performed in the Netherlands between 2014 and 2018. The Hip disability and Osteoarthritis Outcome Score Physical function short form (HOOS-PS), Oxford Hip Score (OHS), EQ-5D index score and thermometer, and Numeric Rating Scales (NRS) measuring pain during activities and at rest, were recorded. The difference between preoperative and 3- and 12-month postoperative scores was calculated (delta-PROM) and used as primary outcome variable. Multivariable linear regression was used to examine the association between patient characteristics (age, sex, ASA score, body mass index (BMI), Charnley class, smoking, and previous operations to the affected hip) and PROMs. Cohens’ d was used to measure effect size. Results: Postoperative improvement (delta-PROM) on HOOS-PS, OHS, EQ-5D, and pain relief were significantly higher in patients <60 years, in patients with female gender, a high ASA score (III–IV), a BMI >30 kg/m2, and patients without a previous operation to the hip. Cohen’s d indicated clinically small differences (0.2). Conclusions: Patients benefiting most in terms of postoperative improvement of self-reported physical functioning, pain relief and quality of life after primary THA were young, female, with a high ASA or BMI score, and without previous operations to the hip.

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Section: Discussionmentioning

confidence: 99%

Which patients improve most after total hip arthroplasty? Influence of patient characteristics on patient-reported outcome measures of 22,357 total hip arthroplasties in the Dutch Arthroplasty Register

et al. 2020

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“…Revision surgery was necessary in 8.4% of all patients, with OB patients showing an increased but not statistically significant tendency to require the most revisions. Another investigation involving a large register study showed an increased revision rate for OB patients [ 42 ]. Sayed-Noor et al found higher 2-year and 5-year revision rates for OW and OB patients in primary THA.…”

Section: Discussionmentioning

confidence: 99%

The Association between High Body Mass Index and Early Clinical Outcomes in Patients with Proximal Femur Fractures

Müller

Gutwerk

Greve

et al. 2020

JCM

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Background: Fractures of the proximal femur constitute daily work in orthopedic trauma surgery. With the continuous increase of obesity in the general population, surgeons face several known technical challenges. The aim of this study was to investigate the association of high body mass index (BMI) in patients with proximal femur fractures with intra- and postoperative adverse events, as well as with functional outcomes after successful surgery. Methods: In this retrospective, single-center cohort study, 950 patients who sustained a fracture of the proximal femur (femoral neck fracture or trochanteric fracture) and underwent surgical treatment at our level I trauma center between 2003 and 2015 were included. Patient-specific data were obtained in regard to demographics, comorbidities, and fracture morphology. In-hospital postoperative complications (i.e., need for revision surgery, wound site infection, pneumonia, urinary tract infection, necessary transfusion, and deep-vein thrombosis) were analyzed, along with the length of hospitalization and overall mortality rate. Functional outcome was assessed using the Barthel index and the patient’s ability to walk on crutches. Mortality rate and need for revision surgery were assessed over a two-year time period. Any adverse event was correlated to one of the four WHO’s BMI groups. Results: The cohort included 80 (8.4%) underweight patients, 570 (60.0%) normal weight patients, 241 (25.4%) overweight patients, and 59 (6.2%) obese patients. We found more femoral neck fractures (506, or 53%) than trochanteric fractures (444, or 47%). In bivariate analysis, no significant difference was found in regard to overall mortality or postoperative complications. Hospitalization time (LOS) differed between the underweight (12.3 ± 4.8 days), normal (13.6 ± 7.8 days), overweight (14.2 ± 11.7 days), and obese patients (16.0 ± 9.7 days) (p = 0.040). Operation time increased stepwise with increasing BMI: underweight = 85.3 ± 42.9 min; normal weight = 90.2 ± 38.2 min; overweight = 99.9 ± 39.9 min; obese = 117.2 ± 61.5 min (p < 0.001). No significant difference was found by analyzing functional outcomes. However, patients with intermediate BMI levels (18.5–30 kg/m2) tended to achieve the best results, as represented by a higher Barthel index score and the patient’s ability to walk on crutches. Conclusion: Increased BMI in patients with proximal femur fractures is associated with both longer operation time and length of hospitalization (LOS). Postoperative mobilization and functional outcomes appear to follow a reversed J-curve distribution (with overweight patients showing the best functional results), whereas both obese and underweight patients have associated poorer function.

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“…It is well recognized and well recorded that obesity is influencing the rate of peri- and postoperative complications in THA and TKA arthroplasty. There are several meta-analyses, including those by Kunutsor et al 18 and reviews by Liu et al, 19 – 21 Ponnusamy et al, 22 Boyce et al, 23 Chaudhry et al, 24 and Sun and Li. 25 They all reported that obesity results in increased rates of infections and revisions secondary to deep infection besides an increase in overall complications.…”

Section: Recommendationsmentioning

confidence: 99%

“…Nevertheless, despite the overall increased complication rate in obese THA and TKA patients, patient-relevant outcome improvements (PROMS) are often comparable to those for non-obese patients. 19 , 21 What this means is that although obese patients rarely achieve the high outcome scores that many non-obese reach in terms of function, as they usually start a lower level preoperatively, their overall gain is often comparable to that of non-obese patients. 23 …”

Section: Recommendationsmentioning

confidence: 99%

EFORT recommendations for off-label use, mix & match and mismatch in hip and knee arthroplasty

Tucker¹,

Günther

Kjærsgaard‐Andersen

et al. 2021

EFORT Open Reviews

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Off-label use is frequently practiced in primary and revision arthroplasty, as there may be indications for the application of implants for purposes outside the one the manufacturers intended. Under certain circumstances, patients may benefit from selective application of mix & match. This can refer to primary hip arthroplasty (if evidence suggests that the combination of devices from different manufacturers has superior results) and revision hip or knee arthroplasty (when the exchange of one component only is necessary and the invasiveness of surgery can be reduced). Within the EFORT ‘Implant and Patient Safety Initiative’, evidence- and consensus-based recommendations have been developed for the safe application of off-label use and mix & match in primary as well as revision hip and knee arthroplasty. Prior to the application of a medical device for hip or knee arthroplasty off-label and within a mix & match situation, surgeons should balance the risks and benefits to the patient, obtain informed consent, and document the decision process appropriately. Nevertheless, it is crucial for surgeons to only combine implants that are compatible. Mismatch of components, where their sizes or connections do not fit, may have catastrophic effects and is a surgical mistake. Surgeons must be fully aware of the features of the components that they use in off-label indications or during mix & match applications, must be appropriately trained and must audit their results. Considering the frequent practice of off-label and mix & match as well as the potential medico-legal issues, further research is necessary to obtain more data about the appropriate indications and outcomes for those procedures. Cite this article: EFORT Open Rev 2021;6:982-1005. DOI: 10.1302/2058-5241.6.210080

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Greater risks of complications, infections, and revisions in the obese versus non-obese total hip arthroplasty population of 2,190,824 patients: a meta-analysis and systematic review

Cited by 50 publications

References 75 publications

Which patients improve most after total hip arthroplasty? Influence of patient characteristics on patient-reported outcome measures of 22,357 total hip arthroplasties in the Dutch Arthroplasty Register

Which patients improve most after total hip arthroplasty? Influence of patient characteristics on patient-reported outcome measures of 22,357 total hip arthroplasties in the Dutch Arthroplasty Register

The Association between High Body Mass Index and Early Clinical Outcomes in Patients with Proximal Femur Fractures

EFORT recommendations for off-label use, mix & match and mismatch in hip and knee arthroplasty

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