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Increasing Reoperations and Failures With Increasing BMI in Patients Undergoing 2-Stage Exchange for Infected Total

Yehuda E Kerbel1, Gregory J Kirchner2, Ariana T Meltzer-Bruhn1

  • 1Dept of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA.

The Journal of Arthroplasty
|April 12, 2021
PubMed
Abstract

Insights

Morbidly obese patients face higher risks of reinfection and reoperation after two-stage prosthetic joint infection (PJI) reimplantation. This highlights the need for pre-operative optimization in this patient group undergoing hip arthroplasty.

Area of Science:

  • Orthopedic surgery
  • Infectious disease
  • Obesity research

Background:

  • Morbid obesity is linked to higher infection rates after total hip arthroplasty.
  • Limited data exists on outcomes of two-stage reimplantation for prosthetic joint infection (PJI) in morbidly obese patients.

Purpose of the Study:

  • To evaluate the impact of morbid obesity (BMI > 40 kg/m2) on reinfection, complications, readmissions, and reoperations after two-stage hip PJI reimplantation.

Main Methods:

  • Retrospective review of 107 patients undergoing first-time two-stage PJI reimplantation (2013-2019).
  • Propensity score matching created three cohorts: nonobese (<30 kg/m2), obese (30-39.9 kg/m2), and morbidly obese (>40 kg/m2).
  • Outcomes compared using chi-square or Fisher's exact tests with minimum 12-month follow-up.

Main Results:

  • Morbidly obese patients had higher reinfection rates (33% vs 0% in nonobese, P=.020) and longer hospital stays (>4 days, 61% vs 19%, P=.012).
  • Morbidly obese patients showed increased return to OR rates (50% vs 13-19%, P=.020).
  • No significant differences noted in overall complications, mortality, or revision surgery rates between groups.

Conclusions:

  • Morbidly obese patients experience significantly higher risks of reinfection and reoperation following two-stage PJI reimplantation.
  • Findings suggest counseling morbidly obese patients on increased risks and considering delayed arthroplasty pending optimization.
  • This study provides crucial data for managing PJI in morbidly obese individuals undergoing hip arthroplasty.
Keywords:
body mass indexcomplicationsobesityperiprosthetic joint infectionrevision total hip arthroplasty

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