Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jan 18, 2015; 6(1): 137-144
Published online Jan 18, 2015. doi: 10.5312/wjo.v6.i1.137
Overweight and obesity in hip and knee arthroplasty: Evaluation of 6078 cases
Daniel Guenther, Stefan Schmidl, Till O Klatte, Harald K Widhalm, Mohamed Omar, Christian Krettek, Thorsten Gehrke, Daniel Kendoff, Carl Haasper
Daniel Guenther, Stefan Schmidl, Till O Klatte, Thorsten Gehrke, Daniel Kendoff, Carl Haasper, Orthopaedic Department, Helios-Endo Klinik Hamburg, Hamburg 22767, Germany
Daniel Guenther, Mohamed Omar, Christian Krettek, Trauma Department, Hannover Medical School (MHH), Hannover 30625, Germany
Till O Klatte, Department of Trauma, Hand, and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
Harald K Widhalm, Department of Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria
Author contributions: Guenther D, Krettek C and Haasper C designed the research; Guenther D, Schmidl S, Klatte TO, Widhalm HK and Omar M performed the research; Guenther D, Schmidl S, Klatte TO and Kendoff D analyzed the data; Guenther D, Haasper C and Gehrke T wrote the paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Daniel Guenther, MD, Orthopaedic Department, Helios-Endo Klinik Hamburg, Holstenstr. 2, Hamburg 22767, Germany. guenther.daniel@mh-hannover.de
Telephone: +49-511-5322026 Fax: +49-511-5325877
Received: April 20, 2014
Peer-review started: April 20, 2014
First decision: June 6, 2014
Revised: July 9, 2014
Accepted: August 27, 2014
Article in press: August 31, 2014
Published online: January 18, 2015
Processing time: 275 Days and 8.2 Hours
Abstract

AIM: To evaluate a possible association between the various levels of obesity and peri-operative charac-teristics of the procedure in patients who underwent endoprosthetic joint replacement in hip and knee joints.

METHODS: We hypothesized that obese patients were treated for later stage of osteoarthritis, that more conservative implants were used, and the intra-and perioperative complications increased for such patients. We evaluated all patients with body mass index (BMI) ≥ 25 who were treated in our institution from January 2011 to September 2013 for a primary total hip arthroplasty (THA) or total knee arthroplasty (TKA). Patients were split up by the levels of obesity according to the classification of the World Health Organization. Average age at the time of primary arthroplasty, preoperative Harris Hip Score (HHS), Hospital for Special Surgery score (HSS), gender, type of implanted prosthesis, and intra-and postoperative complications were evaluated.

RESULTS: Six thousand and seventy-eight patients with a BMI ≥ 25 were treated with a primary THA or TKA. Age decreased significantly (P < 0.001) by increasing obesity in both the THA and TKA. HHS and HSS were at significantly lower levels at the time of treatment in the super-obese population (P < 0.001). Distribution patterns of the type of endoprostheses used changed with an increasing BMI. Peri- and postoperative complications were similar in form and quantity to those of the normal population.

CONCLUSION: Higher BMI leads to endoprosthetic treat-ment in younger age, which is carried out at significantly lower levels of preoperative joint function.

Keywords: Adiposity; Total knee arthroplasty; Total hip arthroplasty; Obesity; Overweight; Prosthesis

Core tip: Our study demonstrates that total hip arthroplasty and total knee arthroplasty can be performed in all stages of obesity with low perioperative risk. We have to mention that good preparation is indispensable. Co-morbities should be assessed and the set-up should be related to high weight. Sometimes special operation-tables, beds, and crutches are required. Higher body mass index leads to endoprosthetic treatment in younger age, which is carried out at significantly lower levels of preoperative joint function.