A comparison of outcomes in morbidly obese, obese and non-obese patients undergoing primary total knee and total hip arthroplasty

Feb 1, 2017The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

Outcomes after knee and hip replacement surgery in severely obese, obese, and non-obese patients

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Abstract

Morbidly obese patients undergoing total knee arthroplasty (TKA) had a mean length of stay one day longer and a 37% rate of postoperative complications.

A total of 1014 TKA and 906 total hip arthroplasty (THA) operations were analyzed.
Morbidly obese patients had a four-point lower mean Oxford knee score compared to non-obese and obese patients after TKA.
Length of stay for morbidly obese TKA patients was one day longer than for those who were non-obese or obese.
For THA, the Oxford hip score decreased by two points with each increasing BMI category.
Postoperative complication rates increased from 25% in non-obese patients to 38% in morbidly obese patients for THA.

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BACKGROUND: Obesity is a growing public health issue with the prevalence of morbid obesity, (Body Mass Index (BMI) ≥ 40 kg/m) increasing. There is some evidence these patients have more peri- and post-operative complications and poorer outcomes when undergoing arthroplasty procedures. This audit aimed to determine and compare the outcomes of non-obese, obese and morbidly obese patients undergoing arthroplasty at our institution. 2

METHOD: This was a retrospective audit of patients from our institution who had undergone total knee (TKA) or total hip arthroplasty (THA) in 2009. Data collected were: age, gender, BMI, length of stay (LOS), Oxford knee or hip score (OKS/OHS), satisfaction and complications up to two years post operation. Patients were divided into three groups: BMI < 30, BMI 30-40 and BMI > 40. Outcomes for each BMI group were compared.

RESULTS: 1014 TKA and 906 THA operations were included. When compared to obese and non-obese patients, morbidly obese patients undergoing TKA had a mean LOS one day longer, a mean OKS four points lower and higher rates of postoperative problems, 37% vs. 21%. For THA patients there was no difference in LOS, OHS score was two points lower for each increasing BMI category and postoperative problems increase from 25% for non-obese to 31% for obese and 38% for morbidly obese patients.

CONCLUSION: These results will be useful in informing obese patients of their potential outcomes following TKA or THA. These patients can then make a more informed choice before proceeding with arthroplasty.

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A comparison of outcomes in morbidly obese, obese and non-obese patients undergoing primary total knee and total hip arthroplasty

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