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Updated: May 15, 2025
Author Spotlight: Advancing Research on Candida albicans Biofilm-Associated Prosthetic Joint Infections
Published on: February 2, 2024
A Systematic Review and Meta-Analysis of Periprosthetic Joint Infection Rates in Morbidly Obese Patients Undergoing
Jared Rubin1, Ajay S Potluri, Kyleen Jan
1From the Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL (Mr. Rubin, Mr. Potluri, Dr. Jan, Dandamudi, and Dr. Levine); and the Department of Orthopedics, Medstar Georgetown University, Washington, DC (Dr. Levine).
Introduction:
Periprosthetic joint infection (PJI) is a severe complication associated with higher rates in obese individuals after total hip arthroplasty (THA). Hard cutoffs for body mass index (BMI) levels may lead to restricted access to care; however, a certain level of obesity may warrant these restrictions for patient safety. The purpose of this study was to perform a systematic review and meta-analysis of articles comparing PJI rates in morbidly versus nonmorbidly obese patients undergoing primary THA.
Methods:
A systematic search of PubMed, EMBASE, Cochrane, and Google Scholar databases was conducted following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Original studies comparing PJI rates in morbidly obese (BMI ≥40 kg/m2) and nonobese (BMI <40 kg/m2) THA patients were included. Data extraction, bias assessment, and quantitative synthesis were done.
Results:
After exclusion criteria, 10 studies comprising 46,080 THAs were included. Morbidly obese patients were found to have markedly higher rates of PJI compared with nonmorbidly obese patients (odds ratio = 4.332, 95% confidence interval [CI], 2.943 to 6.375, I2 = 0, P-value = 0.901). Analysis of cohorts stratified by BMI showed consistent trends; morbidly obese patients demonstrated markedly increased risk of blood transfusions, postoperative fractures, superficial infections, dislocations, readmission within 90 days, surgical complications, and revision surgery.
Conclusion:
Morbidly obese patients demonstrate markedly increased risk of PJI and other complications after primary THA. This should be discussed with patients to safely provide the option of THA while minimizing restrictions on access to care.
