Abstract
PurposeObesity is associated with increased risk for surgical complications in total hip arthroplasty (THA). The impact of obesity on short-term complication in minimally invasive (MIS) anterolateral approach is not well known. Therefore, this study was conducted to evaluate the early complications within the first 90 days after THA using a MIS anterolateral approach with a short-curved stem stratified by Body Mass Index (BMI).Patients and methodsA single centre consecutive series of 1052 hips in 982 patients (index surgery 2014–2019) with a short-curved stem and press fit cup implanted using a MIS anterolateral approach in supine position were screened for inclusion. Inclusion criteria were defined as end-stage primary osteoarthritis of the hip. Eventually, 878 implantations in 808 patients were included and stratified by body mass index (BMI). Peri-operative complications, within the first 90 days after surgery, were retrospectively evaluated.ResultsSeverely obese patients (BMI ≥ 35 kg/m2) and morbidly obese patients (BMI ≥ 40 kg/m2) demonstrated a significantly increased operation time (p < 0.001) and a higher risk for general surgical complications (p = 0.015) (odds ratio (OR) = 4.365; OR = 4.985), periprosthetic joint infection (PJI) (p = 0.001) (OR = 21.687; OR = 57.653), and revision (OR = 8.793; OR = 20.708).ConclusionThe risk for early PJI and overall surgical complications in MIS anterolateral approach is significantly increased in severely and morbidly obese patients. This leads to a significantly higher risk for revision surgery after index surgery within the first 90 days. A BMI above 35 kg/m2 is the clear threshold for increased risk of PJI in MIS anterolateral THA with a short curved stem. As the surgical complications are comparable to other approaches, MIS anterolateral short stem THA is also feasible with increasing BMI.
Highlights
The incidence of obesity has grown in the western world in recent decades [1, 2]
There is no consecutive case series on short-term complications in minimally invasive supine anterolateral approach with a short-curved stem stratified by body mass index (BMI)
Inclusion criteria were defined as end-stage primary osteoarthritis of the hip treated with total hip arthroplasty (THA) performed via a minimally invasive anterolateral approach using the same type of cementless, curved short stem (Fitmore® stem, ZimmerBiomet, Warsaw, IN, USA), and cementless titanium press-fit cup with or without screws (Allofit®/-S, ZimmerBiomet, Warsaw, IN, USA)
Summary
The incidence of obesity has grown in the western world in recent decades [1, 2]. The number of people with the highest body mass index (BMI) is increasing in size at the fastest rate, as evidenced by an annual increase of 50% in prevalence of patients with a BMI ≥ 40 kg/m2 [1, 3, 4]. Studies have shown the higher incidence of peri-operative complications in obese patients and higher rates of revision surgery in total joint arthroplasties in this patient cohort [5,6,7]. Invasive approaches in total hip arthroplasty (THA) have gained more popularity over the last years allowing faster and less painful recovery with fewer post-operative precautions [10,11,12]. Apart from DAA, minimally invasive (MIS) anterolateral approach is established as a MIS approach in THA [15]. Compared to DAA, data on the peri-operative shortterm complications in MIS anterolateral approach in obese patients are rare.
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