Total Hip Arthroplasty Among Superobese Patients: Proceed With Caution

Area of Science:

• Orthopedic Surgery
• Bariatric Medicine
• Public Health

Background:

• Morbid obesity (BMI ≥40 kg/m²) increases perioperative risk in total hip arthroplasty (THA).
• Limited contemporary data exists on outcomes for superobese patients (BMI ≥50 kg/m²) undergoing primary THA.
• This study quantifies complications in superobese THA patients.

Purpose of the Study:

• To assess the risks of infection, surgical, medical, and thromboembolic complications in superobese patients undergoing primary THA.
• To compare outcomes between superobese and normal BMI patients following THA.
• To highlight the need for risk stratification in this population.

Main Methods:

• Utilized the Premier Healthcare Database for primary elective THA patients (2016-2021).
• Compared superobese patients (BMI ≥50 kg/m²) with a normal BMI cohort (18.5-24.9 kg/m²).
• Employed univariate analysis and multivariable regression to analyze 90-day complications.

Main Results:

• Superobese patients showed increased risks for periprosthetic joint infection (aOR: 7.23), sepsis (aOR: 4.24), and wound dehiscence (aOR: 7.61).
• Elevated risks observed for pulmonary embolism (aOR: 4.32), acute respiratory failure (aOR: 2.31), and acute renal failure (aOR: 3.15).
• Superobese cohort had higher rates of hospital readmission (aOR: 2.31).

Conclusions:

• Superobese patients have a substantially higher risk of complications after primary THA.
• Findings underscore the importance of preoperative risk assessment and patient counseling.
• Preoperative optimization strategies are essential for improving outcomes in superobese THA patients.