Total Hip Arthroplasty in Morbidly Obese: Does a Strict Body Mass Index Cutoff Yield Meaningful Change?
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Purpose: The number of obese patients seeking total hip arthroplasty (THA) continues to expand despite body mass index (BMI) cutoffs. We sought to determine the outcomes of THA in the morbidly obese patient, and hypothesized they would have comparable outcomes to two cohorts of obese, and normal weight patients. Materials and Methods: THA performed on morbidly obese patients (BMI >40 kg/m2) at a single academic center from 2010 until 2020 were retrospectively reviewed. Eighty morbidly obese patients were identified, and matched in a 1:3:3 ratio to control cohorts with BMI 30-40 kg/m2 and BMI <30 kg/m2. Acute postoperative outcomes and BMI change after surgery were evaluated for clinical significance with univariate and regression analyses. Cox proportional hazard ratio was calculated to evaluate prosthetic joint infection (PJI) and revision surgery through follow-up. Mean follow-up was 3.9 years. Results: In the acute postoperative period, morbidly obese patients trended towards increased hospital length of stay, facility discharge and 90-day hospital returns. At final follow-up, a higher percentage of morbidly obese patients had clinically significant (>5%) BMI loss; however, this was not significant. Cox hazard ratio with BMI <30 kg/m2 as a reference demonstrated no significant difference in survival to PJI and all-cause revision in the morbidly obese cohort. Conclusion: Morbidly obese patients (BMI >40 kg/m2) require increased resource expenditure in the acute postoperative period. However, they are not inferior to the control cohorts (BMI <30 kg/m2, BMI 30-40 kg/m2) in terms of PJI or all-cause revisions at mid-term follow-up.
Abstract
Purpose: The number of obese patients seeking total hip arthroplasty (THA) continues to expand despite body mass index (BMI) cutoffs. We sought to determine the outcomes of THA in the morbidly obese patient, and hypothesized they would have comparable outcomes to two cohorts of obese, and normal weight patients. Materials and Methods: THA performed on morbidly obese patients (BMI >40 kg/m2) at a single academic center from 2010 until 2020 were retrospectively reviewed. Eighty morbidly obese patients were identified, and matched in a 1:3:3 ratio to control cohorts with BMI 30-40 kg/m2 and BMI <30 kg/m2. Acute postoperative outcomes and BMI change after surgery were evaluated for clinical significance with univariate and regression analyses. Cox proportional hazard ratio was calculated to evaluate prosthetic joint infection (PJI) and revision surgery through follow-up. Mean follow-up was 3.9 years. Results: In the acute postoperative period, morbidly obese patients trended towards increased hospital length of stay, facility discharge and 90-day hospital returns. At final follow-up, a higher percentage of morbidly obese patients had clinically significant (>5%) BMI loss; however, this was not significant. Cox hazard ratio with BMI <30 kg/m2 as a reference demonstrated no significant difference in survival to PJI and all-cause revision in the morbidly obese cohort. Conclusion: Morbidly obese patients (BMI >40 kg/m2) require increased resource expenditure in the acute postoperative period. However, they are not inferior to the control cohorts (BMI <30 kg/m2, BMI 30-40 kg/m2) in terms of PJI or all-cause revisions at mid-term follow-up.
참고문헌 (36)
- Shan L, "Intermediate and long-term quality of life after total knee replacement : a systematic review and meta-analysis", J Bone Joint Surg Am, 97, pp.156~168 (2015)[DOI]
- Long WJ, "Total knee replacement in young, active patients : longterm follow-up and functional outcome : a concise follow-up of a previous report", J Bone Joint Surg Am, 96, pp.e159~ (2014)[DOI]
- Learmonth ID, "The operation of the century : total hip replacement", Lancet, 370, pp.1508~1519 (2007)[DOI]
- Callaghan JJ, "Charnley total hip arthroplasty with cement. Minimum twenty-five-year follow-up", J Bone Joint Surg Am, 82, pp.487~497 (2000)[DOI]
- Flegal KM, "Prevalence and trends in obesity among US adults, 1999-2000", JAMA, 288, pp.1723~1727 (2002)[DOI]
- Stürmer T, "Obesity, overweight and patterns of osteoarthritis : the Ulm Osteoarthritis Study", J Clin Epidemiol, 53, pp.307~313 (2000)[DOI]
- Pottie P, "Obesity and osteoarthritis: more complex than predicted!", Ann Rheum Dis, 65, pp.1403~1405 (2006)[DOI]
- Mokdad AH, "Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001", JAMA, 289, pp.76~79 (2003)[DOI]
- Johnson CA, "Effects of the obesity epidemic on total hip and knee arthroplasty demographics", J Arthroplasty, 36, pp.3097~3100 (2021)[DOI]
- Ward DT, "Complications of morbid obesity in total joint arthroplasty : risk stratification based on BMI", J Arthroplasty, 30(9 Suppl), pp.42~46 (2015)[DOI]
- Werner BC, "Primary total knee arthroplasty in super-obese patients : dramatically higher postoperative complication rates even compared to revision surgery", J Arthroplasty, 30, pp.849~853 (2015)[DOI]
- Courtney PM, "Effect of malnutrition and morbid obesity on complication rates following primary total joint arthroplasty", J Surg Orthop Adv, 25, pp.99~104 (2016)
- Sayeed Z, "Comparing in-hospital total joint arthroplasty outcomes and resource consumption among underweight and morbidly obese patients", J Arthroplasty, 31, pp.2085~2090 (2016)[DOI]
- Froemke CC, "Standardizing care and improving quality under a bundled payment initiative for total joint arthroplasty", J Arthroplasty, 30, pp.1676~1682 (2015)[DOI]
- Iorio R, "Early results of Medicare’s bundled payment initiative for a 90-day total joint arthroplasty episode of care", J Arthroplasty, 31, pp.343~350 (2016)[DOI]
- Clair AJ, "Cost analysis of total joint arthroplasty readmissions in a bundled payment care improvement initiative", J Arthroplasty, 31, pp.1862~1865 (2016)[DOI]
- Malinzak RA, "Morbidly obese, diabetic, younger, and unilateral joint arthroplasty patients have elevated total joint arthroplasty infection rates", J Arthroplasty, 24(6 Suppl), pp.84~88 (2009)[DOI]
- Pruzansky JS, "Prevalence of modifiable surgical site infection risk factors in hip and knee joint arthroplasty patients at an urban academic hospital", J Arthroplasty, 29, pp.272~276 (2014)[DOI]
- Boraiah S, "Management of modifiable risk factors prior to primary hip and knee arthroplasty : a readmission risk assessment tool", J Bone Joint Surg Am, 97, pp.1921~1928 (2015)[DOI]
- Springer BD, "Obesity and total joint arthroplasty : a literature based review", J Arthroplasty, 28, pp.714~721 (2013)[DOI]
- Springer BD, "What are the implications of withholding total joint arthroplasty in the morbidly obese? A prospective, observational study", Bone Joint J, 101-B(7_Supple_C), pp.28~32 (2019)[DOI]
- "Classification of overweight and obesity by BMI, waist circumference, and associated disease risks" (2021)[URL]
- "Guidance for industry developing products for weight management" (2007)[URL]
- Barrett M, "Total hip arthroplasty outcomes in morbidly obese patients : a systematic review", EFORT Open Rev, 3, pp.507~512 (2018)[DOI]
- Bozic KJ, "Patient-related risk factors for periprosthetic joint infection and postoperative mortality following total hip arthroplasty in Medicare patients", J Bone Joint Surg Am, 94, pp.794~800 (2012)[DOI]
- Namba RS, "Obesity and perioperative morbidity in total hip and total knee arthroplasty patients", J Arthroplasty, 20(7 Suppl 3), pp.46~50 (2005)[DOI]
- Andrew JG, "Obesity in total hip replacement", J Bone Joint Surg Br, 90, pp.424~429 (2008)[DOI]
- Mouchti S, "The association of body mass index with risk of long-term revision and 90-day mortality following primary total hip replacement : findings from the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man", J Bone Joint Surg Am, 100, pp.2140~2152 (2018)[DOI]
- McCalden RW, "Does morbid obesity affect the outcome of total hip replacement? : an analysis of 3290 THRs", J Bone Joint Surg Br, 93, pp.321~325 (2011)[DOI]
- McLaughlin JR, "The outcome of total hip replacement in obese and non-obese patients at 10-to 18-years", J Bone Joint Surg Br, 88, pp.1286~1292 (2006)[DOI]
- Duchman KR, "Effects of total knee and hip arthroplasty on body weight", Orthopedics, 37, pp.e278~e285 (2014)[DOI]
- Inacio MC, "Do patients lose weight after joint arthroplasty surgery? A systematic review", Clin Orthop Relat Res, 471, pp.291~298 (2013)[DOI]
- Reeves RA, "The fate of morbidly obese patients with joint pain : a retrospective study of patient outcomes", J Arthroplasty, 36, pp.3101~3107 (2021)[DOI]
- Xu S, "The influence of obesity on functional outcome and quality of life after total knee arthroplasty : a ten-year follow-up study", Bone Joint J, 100-B, pp.579~583 (2018)[DOI]
- Chen JY, "The influence of body mass index on functional outcome and quality of life after total knee arthroplasty", Bone Joint J, 98-B, pp.780~785 (2016)[DOI]
- Giori NJ, "Risk reduction compared with access to care : quantifying the trade-offof enforcing a body mass index eligibility criterion for joint replacement", J Bone Joint Surg Am, 100, pp.539~545 (2018)[DOI]
