Obesity and Perioperative Morbidity in Total Hip and Total Knee Arthroplasty Patients

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Abstract

The incidence of obesity in 1071 total hip arthroplasty (THA) patients and 1813 total knee arthroplasty (TKA) patients and its effect on perioperative morbidity were evaluated prospectively. Fifty-two percent of TKA and 36% of THA patients were obese (body mass index ≥30). The obese patients were significantly younger, with a higher proportion of obese TKA patients being women. Higher rates of diabetes and hypertension were found in obese patients. Higher postoperative infection rates were observed in patients with body mass index 35 or higher. The odds ratio was 6.7 times higher risk for infection in obese TKA patients and 4.2 times higher for obese THA patients. The increased risk of infection in obese patients undergoing total joint arthroplasty must be realized by both the patient and surgeon.

Section snippets

Definitions of Obesity

A BMI of greater than 30 is a widely accepted measurement of obesity 1, 2. In this study, we further designated patients as being “highly obese” if their BMI exceeded 35. Categorizing patients with a BMI greater than 35 has been found to stratify differences among patients undergoing TKA [9]. A BMI greater than 40 is defined as morbid obesity.

Patient Samples

Patients were identified using a prospective registry that records patient demographics and comorbidities, details on the surgical procedure, implant

Results

Obesity (BMI ≥30) was more prevalent in TKA patients (52%) than THA patients (36%, P < .001). TKA patients were also more likely to be highly obese (BMI ≥35; 23%) than THA patients (14%, P < .001). Similarly, morbid obesity (BMI ≥40) was more prevalent in TKA (11%) than THA (5%) patients (P < .001).

Table 1, Table 2 present patient demographics, comorbidities, and outcomes for highly obese (BMI ≥35) and non–highly obese (BMI ≤35) patients who underwent THA or TKA. The highly obese THA and TKA

Discussion

The prevalence of obesity in patients undergoing elective orthopedic procedures is high but is particularly high for the knee joint 1, 2, 3. The prevalence of obesity (BMI ≥30) in the United States is estimated to be 30% in the general population [14]. In our series, 52% of the TKA patients were obese, considerably higher than the national average. The TKA patients with BMI 35 or higher (highly obese) were significantly younger, further supporting the strong association of obesity and knee

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All of authors received support in the form of an unrestricted research grant from Depuy, Zimmer, and Smith and Nephew.

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