Complications - Other
Obesity is Associated With Early Total Hip Revision for Aseptic Loosening

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Abstract

Background

Obesity affects more than half a billion people worldwide, including one-third of men and women in the United States. Obesity is associated with higher postoperative complication rates after total hip arthroplasty (THA). It remains unknown whether obese patients progress to revision THA faster than nonobese patients.

Methods

A total of 257 consecutive primary THAs referred to an academic tertiary care center for revision THA were retrospectively stratified according to preoperative body mass index (BMI), reason for revision THA, and time from primary to revision THA.

Results

When examining primary THAs referred for revision THA, increasing BMI adversely affected the mean time to revision THA. The percentage of primary THAs revised at 5 years was 25% for a BMI of 18-25, 38% for a BMI of 25-30, 56% for a BMI of 30-35, 73% for a BMI of 35-40, and 75% for a BMI of greater than 40 (P < .001). The percentage of primary THAs revised at 15 years was 70%, 82%, 87%, 94%, and 100%, respectively (P < .001). A significant increase in early revision THA for aseptic loosening/osteolysis in obese patients (56%, 23/41) when compared with the nonobese patients (12%, 10/83, P < .001, relative risk ratio = 4.7).

Conclusion

Preoperative BMI influences the time of failure of primary THAs referred to an academic tertiary care for revision THA as well as the mechanism of failure. Specifically, obesity increased in the relative risk of early revision THA due to aseptic loosening/osteolysis by 4.7 fold.

Section snippets

Materials and Methods

Using the total joint registry of our institution (a tertiary care center), we retrospectively reviewed 273 primary THAs (261 patients) referred to Stanford Healthcare for a revision THA performed in a 3 year interval between January 2011 to December 2014. Sixteen patients were excluded from this study because they did not have a preoperative BMI or date of primary THA. As such, 257 primary THAs (245 patients) were reviewed for the final analysis. Age, gender, American Society of Anesthesiology

Results

When examining primary THAs referred for revision THA, the mean time from primary to revision THA was 8.7 ± 8.1 years. The time from primary THA to revision THA was directly correlated with increasing BMI (Fig. 1). The percentage of primary THAs revised at 5 years was 25% for a BMI of 18-25, 38% for a BMI of 25-30, 56% for a BMI of 30-35, 73% for a BMI of 35-40, and 75% for a BMI of more than 40 (P < .001). The percentage of primary THAs revised at 15 years was 70%, 82%, 87%, 94%, and 100%,

Discussion

The increasing number of patients undergoing primary THA coupled with the obesity epidemic should increase the number of obese and morbidly obese patients undergoing revision THA 4, 19, 20. Currently, there is conflicting evidence on whether obesity adversely impacts the survival of primary THA. In a large population-based survival analysis, Culliford et al. [18] showed that BMI is estimated to have a small but statistically significant association with risk of revision THA. However, little is

Acknowledgments

The authors thank Ms. Angela Bye and Dr. Subhrojyoti Bhowmick for their assistance searching the arthroplasty registry the Department of Orthopaedic Surgery at the Stanford Hospital and Clinics as well as selected editing of this manuscript.

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    One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to http://dx.doi.org/10.1016/j.arth.2016.02.073.

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