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Related Experiment Video

Updated: Feb 10, 2026

Individualized Stem-positioning in Calcar-guided Short-stem Total Hip Arthroplasty
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Dislocation rate increases with bariatric surgery before total hip arthroplasty.

Brian T Nickel1, Mitchell R Klement1, Colin Penrose1

  • 11 Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA.

Hip International : the Journal of Clinical and Experimental Research on Hip Pathology and Therapy
|May 15, 2018
PubMed
Summary

Bariatric surgery (BS) patients undergoing total hip arthroplasty (THA) face higher complication risks, including dislocation and infection, compared to obese or normal-weight controls. These risks persist even after BS, suggesting potential challenges in visualization and tissue integrity.

Keywords:
Bariatric surgerydislocationobesitytotal hip arthroplasty

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Area of Science:

  • Orthopedic Surgery
  • Bariatric Surgery
  • Health Services Research

Background:

  • Annually, 113,000 patients with refractory obesity undergo bariatric surgery (BS) in the USA.
  • A subset of these patients opts for BS to lower BMI and become better candidates for total hip arthroplasty (THA).

Purpose of the Study:

  • To evaluate the risk of total hip arthroplasty (THA) complications in patients who underwent bariatric surgery (BS) prior to THA.
  • To compare THA complication rates between patients with prior BS and control groups (obese and normal weight) without BS.

Main Methods:

  • A claim-based review of the Medicare database identified 12,160 patients.
  • Patients were categorized into three groups: prior BS (Group I), obese without BS (Group II), and normal weight without BS (Group III).
  • Preoperative factors and short-term (30-day) and long-term (90-day, 2-year) complications were analyzed.

Main Results:

  • Group I (prior BS) showed a higher incidence of deficiency anemia, cardiovascular disease, liver disease, diabetes, polysubstance abuse, psychiatric disorders, and smoking.
  • At two years, Group I had double the risk of dislocation and revision compared to Groups II and III.
  • Groups I and II had over four times the risk of infection and wound complications compared to Group III.

Conclusions:

  • Patients undergoing THA after BS in the Medicare population exhibit complication rates similar to or greater than obese patients without prior BS.
  • Increased dislocation risk may stem from ligamentous laxity or intraoperative visualization challenges.
  • These findings highlight persistent risks for THA patients with a history of bariatric surgery.