Obesity is not associated with hip failure in patients with articular surface replacement of the hip

Our main aim was to investigate whether obese patients were at increased risk of elevated metal ion levels and/or adverse local tissue reaction (ALTR) after being treated with articular surface replacement (ASR) hip arthroplasty.

This study included 360 patients who underwent metal-on-metal (MoM) hip resurfacing (HRA) or total hip arthroplasty (THA). 95 patients (26%) were underweight/normal weight (BMI < 25 kg/m²), 139 (39%) were overweight (BMI 25-30 kg/m²), and 126 (36%) were obese (BMI ⩾ 30 kg/m²). Blood metal ion levels and patient-reported outcome measures (PROMs) were obtained, and a sub-cohort of 85 patients had MARS MRI performed. Logistic regression analyses were used to assess the associations between obesity and metal ions, as well as ALTR.

BMI was not associated with either elevated metal ion levels or ALTR. In HRA patients, female gender (OR 3.0; p = 0.019) and pain (OR 2.3; p = 0.046) were associated with elevated Co levels. Female patients had increased risk of elevated Cr levels (OR 3.0; p = 0.02). In THA patients, female gender (OR 2.2; p = 0.004) and VAS satisfaction (OR 2.1; p = 0.01) were associated with elevated Co levels. Female gender (OR 3.6; p = 0.001) and time from surgery (OR 1.4; p = 0.005) were associated with Cr levels. In the sub-cohort, ALTR was associated with Co levels (OR 16.1; p = 0.002) in HRA patients.

Patients with BMI ⩾ 30 kg/m² present no increased risk for elevated metal ion levels or development of ALTR.