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

J R Onggo; J D Onggo; R de Steiger; R Hau

doi:10.1016/j.joca.2019.10.005

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

Osteoarthritis Cartilage. 2020 Jan;28(1):31-44. doi: 10.1016/j.joca.2019.10.005. Epub 2019 Nov 7.

Authors

J R Onggo¹, J D Onggo², R de Steiger³, R Hau⁴

Affiliations

¹ Department of Orthopaedic Surgery, Box Hill Hospital, 8 Arnold Street, Box Hill, VIC 3128, Melbourne, Australia. Electronic address: jamesonggo1993@hotmail.com.
² Department of Orthopaedic Surgery, Box Hill Hospital, 8 Arnold Street, Box Hill, VIC 3128, Melbourne, Australia. Electronic address: jasononggo@hotmail.com.
³ Department of Surgery Epworth Healthcare, University of Melbourne, Parkville, VIC 3010, Melbourne, Australia. Electronic address: richard.desteiger@epworth.org.au.
⁴ Department of Orthopaedic Surgery, Box Hill Hospital, 8 Arnold Street, Box Hill, VIC 3128, Melbourne, Australia; Department of Orthopaedic Surgery, Epworth Eastern Hospital, 1 Arnold Street, Box Hill, VIC 3128, Melbourne, Australia. Electronic address: raphaelhau@hotmail.com.

PMID: 31705995
DOI: 10.1016/j.joca.2019.10.005

Abstract

Background: Obesity is an epidemic, especially in developed countries. This affects the general health of these patients, especially when they are having a major surgical procedure such as total hip arthroplasty (THA). Several articles have described the effects of obesity on THA with varying conclusions. This meta-analysis aims to compare the outcomes, complications, and peri-operative parameters of THA in the obese (BMI≥30 kg/m²) vs non-obese (BMI<30 kg/m²) population as well as a subgroup analysis of morbidly obese (BMI≥40 kg/m²) vs non-obese population.

Methods: A multi-database search was performed according to PRISMA guidelines. Data from studies assessing the outcomes and complications of THA in the obese and non-obese population were extracted and analyzed.

Results: Sixty-seven studies were included in this meta-analysis, consisting of 581,012 obese and 1,609,812 non-obese patients. Meta-analysis could not be performed on patient reported outcome measures due to heterogeneous reporting methods. Obese patients had a higher risk of all complications (OR = 1.53, 95%CI: 1.30-1.80, P < 0.001), deep infections (OR = 2.71, 95%CI: 2.08-3.53, P < 0.001), superficial infections (OR = 1.99, 95%CI: 1.55-2.55, P < 0.001), dislocations (OR = 1.72, 95%CI: 1.66-1.79, P < 0.001), reoperations (OR = 1.61, 95%CI: 1.40-1.85, P < 0.001), revisions (OR = 1.44, 95%CI: 1.32-1.57, P < 0.001), and readmissions (OR = 1.37, 95%CI: 1.15-1.63, P < 0.001). When sub-group analysis of morbidly obese (BMI≥40 kg/m²) patients was performed, the risks of all these parameters were even greater.

Conclusion: Obese and morbidly obese patients are at higher risks of complications post THA than non-obese patients. Surgeons should be aware of these risks in order to counsel patients and adopt prophylactic strategies to reduce these risks where applicable.

Keywords: Complications; Morbid obesity; Obesity; Outcomes; Total hip arthroplasty; Total hip replacement.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Arthroplasty, Replacement, Hip / adverse effects*
Case-Control Studies
Humans
Obesity / complications*
Reoperation / statistics & numerical data*
Risk Factors
Surgical Wound Infection / etiology*