LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA.
Hip Int. 2023 Sep;33(5):806-811. doi: 10.1177/11207000221144740. Epub 2023 Jan 26.
Over ⅓ of the population in the United State is obese (body mass index [BMI] >30 kg/m), with an increasing proportion being morbidly obese (BMI >40 kg/m). As the obesity rate climbs, an increasing number have entered the super-obese category (BMI >50 kg/m), theoretically increasing risk for complications after total hip arthroplasty (THA). This study compared complications in non-obese, obese, morbidly obese, and super-obese patients undergoing THA. We specifically assessed: (1) 1- and 2-year peri-prosthetic joint infection (PJI) rates; (2) complication rates; as well as (3) 1- and 2-year revision rates.
A database review identified patients undergoing primary THA from 01 January 2010 to 31 December 2019. Patients were stratified based on the presence of International Classification of Diseases, 9th and 10th revision diagnosis codes of non-obese (BMI <30 kg/m) ( 8680), obese (BMI <40 kg/m) ( 12,443), morbidly obese (BMI <50 kg/m) ( 5250), and super-obese (BMI >50 kg/m) ( 814) prior to THA. Complication rates at 90 days, 1 year, and 2 years were compared across groups.
At all time points, super-obese patients were associated with higher rates of PJI, even when compared to morbidly obese patients. Complications such as sepsis, venous thrombo-embolism, and revision surgeries were found in higher numbers in super-obese as well as morbidly obese patients, compared to obese and non-obese patients.
This study provides large-scale analyses demonstrating the association between super-obese and morbidly obese patients and higher infection rates, as well as complications, following THA. Importantly, the association of PJI is highest among super-obese patients, even when compared to morbidly obese patients. Attaining a BMI <40 kg/m prior to surgery may be an important goal discussed with patients to lower the chance of postoperative infections.
美国超过三分之一的人口肥胖（体重指数 [BMI] > 30 kg/m），其中越来越多的人患有病态肥胖（BMI > 40 kg/m）。随着肥胖率的攀升，越来越多的人进入超级肥胖类别（BMI > 50 kg/m），这理论上增加了全髋关节置换术后（THA）并发症的风险。本研究比较了接受 THA 的非肥胖、肥胖、病态肥胖和超级肥胖患者的并发症。我们特别评估了：（1）1 年和 2 年假体周围关节感染（PJI）的发生率；（2）并发症发生率；以及（3）1 年和 2 年的翻修率。
数据库回顾确定了 2010 年 1 月 1 日至 2019 年 12 月 31 日期间接受初次 THA 的患者。根据国际疾病分类，第 9 和第 10 修订版诊断代码，将患者分为非肥胖（BMI < 30 kg/m）（8680）、肥胖（BMI < 40 kg/m）（12,443）、病态肥胖（BMI < 50 kg/m）（5250）和超级肥胖（BMI > 50 kg/m）（814）患者。比较各组患者在 90 天、1 年和 2 年时的并发症发生率。
在所有时间点，超级肥胖患者的 PJI 发生率均高于病态肥胖患者，即使与超级肥胖患者相比也是如此。与肥胖和非肥胖患者相比，超级肥胖和病态肥胖患者的败血症、静脉血栓栓塞和翻修手术等并发症的数量更多。
本研究提供了大规模分析，表明超级肥胖和病态肥胖患者与 THA 后更高的感染率以及并发症之间存在关联。重要的是，超级肥胖患者的 PJI 发生率最高，甚至高于病态肥胖患者。在手术前将 BMI 控制在<40 kg/m 可能是与患者讨论的一个重要目标，以降低术后感染的机会。
