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Complications Following Hip Replacement More
Common In Obese Patients, Especially Women
Anne Lübbeke, Richard Stern, Guido Garavaglia,
Line Zurcher, Pierre Hoffmeyer,
04 Mar 2007
Obese patients tend to have a higher prevalence of total hip
replacements due to a higher incidence of hip osteoarthritis.
This is of particular concern in light of the trend in rising
rates of obesity in developed countries. A new study published
in the March 2007 issue of Arthritis Care & Research evaluated
the effects of obesity on complications and outcomes following
total hip replacements and investigated whether the results
differed in obese women and men.
Led by Anne Lübbeke, M.D., MSc, of the Geneva University
Hospital in Geneva, Switzerland, researchers conducted a study
of all patients who underwent total hip replacements between
March 1996 and July 2005 at their hospital. Of the 2,495 hip
replacements (some were bilateral), 589 were performed in obese
patients, with a higher prevalence of obese males than females.
Obesity was defined as a body mass index equal to or greater
than 30 kg/m2. Researchers evaluated the incidence of infection,
dislocation, and revision (redoing the replacement), as well as
quality of life, satisfaction, and general health five years
after undergoing a hip replacement.
The results showed that obesity was associated with a
substantially higher risk for infection in women, led to more
dislocations (with a greater increase in women), and resulted in
more revisions due to septic loosening (caused by infection).
After five years, outcomes for 635 hips in non-obese patients
and 183 hips in obese patients were evaluated. Obese women, but
not obese men, reported moderately lower functional outcomes and
slightly less satisfaction, mostly due to a higher incidence of
complications.
The risk factors for infection that are known to be more
frequent in obese patients, such as longer operating time and
diabetes, were not related to females in the study and do not
explain why the women had poorer results. The researchers
suggest that other reasons related to sex differences, such as
body fat distribution and metabolic response, might be involved.
They also note that the higher number of dislocations in obese
women may be due to the lower peripheral muscle strength seen in
this group of patients, while the lower functional outcomes may
be due to additional factors such as a higher incidence of
osteoarthritis.
"To the best of our knowledge, this is the first study analyzing
sex differences as related to outcomes in obese THA [total hip
replacement] patients," the authors state. They note that
previous studies on the relationship between obesity,
complications, and outcomes following hip replacement are
contradictory, but the results are muddied by a lack of
information on sex, multiple definitions of obesity, and a
limited interpretation of complications. "Because our study
revealed increased complications among obese women, we suggest
that surgeons counsel this group of patients so that they are
made aware of this fact," the authors conclude. "In addition,
participating in a weight-loss program prior to surgery might be
beneficial for such patients."
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