Telang Sagar, Palmer Ryan, Chung Brian C, Ball Jacob R, Hong Kurt, Lieberman Jay R, Heckmann Nathanael D
Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
Department of Orthopaedic Surgery, University of California, Davis School of Medicine, Sacramento, CA, USA.
Arthroplast Today. 2025 Jul 14;34:101770. doi: 10.1016/j.artd.2025.101770. eCollection 2025 Aug.
Morbid obesity, defined as body mass index (BMI) ≥40 kg/m, increases perioperative risk following total hip arthroplasty (THA). However, limited contemporary data exists on outcomes of superobese patients (BMI ≥50 kg/m) following primary THA. Using a large modern cohort, this study seeks to quantify the risk of infection and surgical, medical, and thromboembolic complications among superobese THA patients.
The Premier Healthcare Database was queried to identify all primary elective THA patients between 2016 and 2021. All superobese patients were compared to a normal BMI cohort (BMI 18.5-24.9 kg/m). Univariate analysis and multivariable regression were utilized to assess differences in primary outcomes, including 90-day infectious, surgical, medical, and thromboembolic complications.
Twenty-one thousand, thirty-five THA patients were identified; 888 patients (4.2%) had a BMI ≥50 kg/m, while 20,147 patients (95.8%) had a BMI 18.5-24.9 kg/m. On multivariable analysis, superobese patients demonstrated an increased risk of infectious and surgical complications, including periprosthetic joint infection (adjusted odds ratio [aOR]: 7.23, 95% confidence interval (CI): 3.95-13.24, < .001), sepsis (aOR: 4.24, 95% CI: 2.19-9.23, < .001), and wound dehiscence (aOR 7.61, 95% CI: 3.90-14.85, < .001). The risk of pulmonary embolism (aOR 4.32, 95% CI: 1.75-10.64, = .001), acute respiratory failure (aOR: 2.31, 95% CI: 1.32-4.05, = .003), acute renal failure (aOR: 3.15, 95% CI: 2.19-4.52, < .001), and hospital readmission (aOR: 2.31, 95% CI: 1.75-3.07, < .001) were similarly elevated within the superobese cohort.
Superobese patients face markedly increased risk for infection and surgical, medical, and thromboembolic complications following primary THA. Our findings emphasize the importance of preoperative risk stratification, optimization, and patient counseling in this high-risk cohort.
病态肥胖定义为体重指数（BMI）≥40kg/m²，会增加全髋关节置换术（THA）后的围手术期风险。然而，关于超级肥胖患者（BMI≥50kg/m²）初次THA术后结局的当代数据有限。本研究使用一个大型现代队列，旨在量化超级肥胖THA患者感染、手术、内科及血栓栓塞并发症的风险。
查询Premier医疗数据库，以识别2016年至2021年间所有初次择期THA患者。将所有超级肥胖患者与正常BMI队列（BMI 18.5 - 24.9kg/m²）进行比较。采用单因素分析和多变量回归来评估主要结局的差异，包括90天感染、手术、内科及血栓栓塞并发症。
共识别出21035例THA患者；888例患者（4.2%）BMI≥50kg/m²，而20147例患者（95.8%）BMI为18.5 - 24.9kg/m²。多变量分析显示，超级肥胖患者感染和手术并发症风险增加，包括假体周围关节感染（调整优势比[aOR]：7.23，95%置信区间[CI]：3.95 - 13.24，P <.001）、脓毒症（aOR：4.24，95% CI：2.19 - 9.23，P <.001）和伤口裂开（aOR 7.61，95% CI：3.90 - 14.85，P <.001）。超级肥胖队列中肺栓塞（aOR 4.32，95% CI：1.75 - 10.64，P =.001）、急性呼吸衰竭（aOR：2.31，95% CI：1.32 - 4.05，P =.003）、急性肾衰竭（aOR：3.15，95% CI：2.19 - 4.52，P <.001）及再次入院（aOR：2.31，95% CI：1.75 - 3.07，P <.001）的风险同样升高。
超级肥胖患者初次THA术后感染、手术、内科及血栓栓塞并发症风险显著增加。我们的研究结果强调了术前风险分层、优化及患者咨询在这一高危队列中的重要性。
