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

Issa, Kimona MD1,2; Harwin, Steven F. MD3; Malkani, Arthur L. MD4; Bonutti, Peter M. MD5; Scillia, Anthony MD2; Mont, Michael A. MD1,a

doi: 10.2106/JBJS.O.00474
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Background: The purpose of this study was to assess the clinical and patient-reported outcomes of primary total hip arthroplasty in super-obese patients (those with a body mass index [BMI] of ≥50 kg/m2) compared with a matched group of patients who had a normal BMI (<30 kg/m2). A secondary objective was to assess patients’ experiences in finding a treating surgeon.

Methods: Forty-eight hips in forty-five patients who had a minimum BMI of 50 kg/m2 and who had undergone a primary total hip arthroplasty at one of four high-volume institutions between 2001 and 2010 were reviewed. This included twenty-six women and nineteen men who had a mean age of fifty-four years (range, thirty-six to seventy-one years) and who were followed for a mean time of six years (range, four to twelve years). These patients were compared in a 1:3 ratio with a non-obese matched group (those with a BMI of <30 kg/m2) of 135 patients who had undergone total hip arthroplasty during the same time period by the same surgeons. The outcomes evaluated included implant survivorship, complication rates, Harris hip scores, 36-item Short-Form (SF)-36 questionnaires, University of California Los Angeles (UCLA) activity scores, and patient experience in finding a treating surgeon.

Results: The super-obese group had a 4.5 times higher odds ratio of undergoing a revision when compared with the matching group (p = 0.06); the overall implant survivorship was 89.6% for the super-obese group and 97.8% for the matching group. The super-obese group also had a significantly higher odds ratio (7.7) of complications compared with the matching group (p = 0.017). The super-obese group also had significantly lower mean values for the Harris hip score (82 points for the super-obese group compared with 91 points for the matched group; p = 0.002), the SF-36 Physical Component Summary score (39 points for the super-obese group and 49 points for the matched group; p = 0.001), the SF-36 Mental Component Summary scores (46 points for the super-obese group and 58 points for the matched group; p = 0.001), and the UCLA activity score (3.9 points for the super-obese group compared with 6.2 points for the matched group; p = 0.001). Compared with the matched group, super-obese patients were evaluated by a larger number of orthopaedic surgeons prior to undergoing total hip arthroplasty.

Conclusions: 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.

Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

1Sinai Hospital of Baltimore, Baltimore, Maryland

2Department of Orthopaedic Surgery, Seton Hall University of Health and Medical Sciences, South Orange, New Jersey

3Mount Sinai Beth Israel, New York, NY

4Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky

5Bonutti Clinic, Effingham, Illinois

aE-mail address for M.A. Mont: mmont@lifebridgehealth.org

Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated
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