Greater risks of complications, infections, and revisions in the obese versus non-obese total hip arthroplasty population of 2,190,824 patients: a meta-analysis and systematic review

Abstract

Obesity is an epidemic, especially in developed countries. This affects the general health of these patients, especially when they are having a major surgical procedure such as total hip arthroplasty (THA). Several articles have described the effects of obesity on THA with varying conclusions. This meta-analysis aims to compare the outcomes, complications, and peri-operative parameters of THA in the obese (BMI≥30kg/m2) vs non-obese (BMI<30kg/m2) population as well as a subgroup analysis of morbidly obese (BMI≥40kg/m2) vs non-obese population. A multi-database search was performed according to PRISMA guidelines. Data from studies assessing the outcomes and complications of THA in the obese and non-obese population were extracted and analyzed. Sixty-seven studies were included in this meta-analysis, consisting of 581,012 obese and 1,609,812 non-obese patients. Meta-analysis could not be performed on patient reported outcome measures due to heterogeneous reporting methods. Obese patients had a higher risk of all complications (OR=1.53, 95%CI: 1.30-1.80, P<0.001), deep infections (OR=2.71, 95%CI: 2.08-3.53, P<0.001), superficial infections (OR=1.99, 95%CI: 1.55-2.55, P<0.001), dislocations (OR=1.72, 95%CI: 1.66-1.79, P<0.001), reoperations (OR=1.61, 95%CI: 1.40-1.85, P<0.001), revisions (OR=1.44, 95%CI: 1.32-1.57, P<0.001), and readmissions (OR=1.37, 95%CI: 1.15-1.63, P<0.001). When sub-group analysis of morbidly obese (BMI≥40kg/m2) patients was performed, the risks of all these parameters were even greater. Obese and morbidly obese patients are at higher risks of complications post THA than non-obese patients. Surgeons should be aware of these risks in order to counsel patients and adopt prophylactic strategies to reduce these risks where applicable.