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Body Mass Index as a Risk Factor for Readmission Rates in Direct Anterior Approach Total Hip Arthroplasty.

Evan R Simpson1, Parke Hudson1, Viraj Deshpande1

  • 1Hoag Orthopedics, Irvine, CA.

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|April 17, 2025
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Obese class III patients undergoing direct anterior hip arthroplasty face higher 30-day readmission rates and infection risks. Surgeons should discuss these body mass index-related complications with patients.

Keywords:
BMIPerioperative complicationsPrimary total hip arthroplasty

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Area of Science:

  • Orthopaedic Surgery
  • Surgical Complications
  • Patient Outcomes

Background:

  • Obesity is linked to increased perioperative complications in total hip arthroplasty (THA).
  • Direct anterior (DA) approach THA is a common surgical technique.
  • Understanding BMI-specific risks is crucial for patient management.

Purpose of the Study:

  • To compare perioperative complication rates in patients undergoing DA THA, stratified by body mass index (BMI).

Main Methods:

  • Retrospective review of 4767 DA THA cases (Jan 2019 - Aug 2022).
  • Patients categorized into BMI groups: underweight, normal, overweight, obese class I, II, and III.
  • Primary outcomes: 30/90-day readmissions, ED visits, intraoperative fracture, 90-day surgical site infection.

Main Results:

  • Obese class III patients (BMI ≥ 40) had significantly higher 30-day readmission rates (6.2%) compared to other BMI groups.
  • Underweight patients showed increased odds of intraoperative fracture (OR: 13.12).
  • Obese classes I and III had higher odds of 90-day infection requiring reoperation (OR: 8.51 and 29.85, respectively).

Conclusions:

  • Obese class III patients exhibit elevated 30-day readmission risk after DA THA.
  • Increased risk of infection requiring surgery is noted in obese class I and III patients.
  • Surgeons must counsel patients on BMI-related risks for DA THA.