Does body mass index affect the rate of adverse outcomes in total hip and knee arthroplasty? A retrospective review of a total joint replacement database

Mar 28, 2020Canadian journal of surgery. Journal canadien de chirurgie

Body mass index and its link to complications after total hip and knee replacement surgery

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Abstract

A total of 27,387 patients underwent hip or knee arthroplasty, revealing that increased body mass index (BMI) is associated with higher in-hospital medical events and complications.

Patients with increased BMI experienced a higher rate of deep infection following both hip and knee arthroplasty.
Those with higher BMI were less likely to be discharged home compared to patients with normal weight.
Increased BMI was linked to an increase in 30-day readmission rates and longer hospital stays in the hip arthroplasty cohort.
Patients with a BMI of 30 kg/m2 or greater required a total hip arthroplasty 1.7 years earlier than those of normal weight, with the need for surgery advancing further with higher BMI categories.
In the knee arthroplasty cohort, a BMI of 30 kg/m2 or greater resulted in surgery being required 2.7 years earlier than for normal weight patients.

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BACKGROUND: Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are reliable surgical options to treat pain and disability resulting from degenerative conditions around the hip and knee. Obesity is a modifiable risk factor that contributes to significant morbidity. The purpose of this study was to retrospectively compare outcomes in primary hip and knee arthroplasty for patients with increased body mass index (BMI) and those with normal BMI, using data from the registry of the Alberta Bone and Joint Health Institute (ABJHI).

METHODS: We retrospectively reviewed the data compiled in the ABJHI registry between March 2010 and July 2016. We reviewed outcomes with respect to length of stay, discharge destination, 30-day readmission, postoperative infection, postoperative transfusion requirements, postoperative adverse events and in-hospital postoperative mechanical complications.

RESULTS: A total of 10 902 patients (6076 women, 4826 men) who underwent THA and 16 485 patients (10 057 women, 6428 men) who underwent TKA were included in the study. For both THA and TKA, patients with increased BMI had an increased number of in-hospital medical events, had an increased rate of deep infection, were less likely to be discharged home (p < 0.001) and had decreased transfusion requirements (p < 0.001) than patients whose weight was in the normal range. Increased BMI increased the rate of 30-day readmission and length of stay in the THA cohort but not in the TKA cohort. Increased BMI had no effect on acute postoperative dislocation or periprosthetic fractures. Patients with a BMI of 30 kg/m2 or greater required a THA 1.7 years earlier than patients of normal weight, patients whose BMI was 35 kg/m2 or greater required a THA 3.4 years earlier, and patients whose BMI was 40 kg/m2 or greater required a THA 5.8 years earlier. In the TKA cohort, patients with a BMI of 30 kg/m2 or greater required a TKA 2.7 years earlier than patients whose weight was in the normal range, patients with a BMI of 35 kg/m2 or greater required a TKA 4.6 years earlier, and patients whose BMI was 40 kg/m2 or greater required a TKA 7.6 years earlier.

CONCLUSION: Our study quantifies the effects of obesity in primary hip and knee arthroplasty. It provides a greater understanding of the risks in the obese population when contemplating joint arthroplasty.

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Does body mass index affect the rate of adverse outcomes in total hip and knee arthroplasty? A retrospective review of a total joint replacement database

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