Overweight and obesity in hip and knee arthroplasty: Evaluation of 6078 cases

Table 1 Distribution of patients to the different degrees of overweight and obesity

BMI (kg/m2)	25-29.9total	(Overweight)percent	30-34.9total	(Stage I)percent	35-39.9total	(Stage II)percent	≥40total	(Stage III)percent	Totalamount
THA	1920	60.5%	899	28.3%	285	9.0%	70	2.2%	3174
TKA	1394	48.0%	961	33.1%	432	14.9%	117	4.0%	2904
THA and TKA	3314	54.5%	1860	30.6%	717	11.8%	187	3.1%	6078

THA: Total hip arthroplasty; TKA: Total knee arthroplasty; BMI: Body mass index.

Table 2 Comorbidities in total hip arthroplasty and total knee arthroplasty

BMI (kg/m2)	25-29.9total	(Overweight)percent	30-34.9total	(Stage I)percent	35-39.9total	(Stage II)percent	≥40total	(Stage III)percent
Anemia	498	15.00%	273	14.70%	106	14.80%	27	14.40%
Cancer diseases	9	0.30%	6	0.30%	3	0.40%	1	0.50%
Congestive heart failure	86	2.60%	48	2.60%	19	2.60%	5	2.70%
Chronic pulmonary disease	629	19.00%	353	19.00%	136	19.00%	36	19.30%
Coagulopathy	23	0.70%	13	0.70%	5	0.70%	1	0.50%
Depression	497	15.00%	279	15.00%	108	15.10%	28	15.00%
Diabetes	1100	33.20%	616	33.10%	238	33.20%	67	35.80%
Fluid and electrolyte disorder	230	6.90%	130	7.00%	50	7.00%	15	8.00%
Gastro esophageal reflux disease	63	1.90%	35	1.90%	14	2.00%	6	3.20%
Hypertension	2550	76.90%	1431	76.90%	553	77.10%	148	79.10%
Hypothyroidism	497	15.00%	279	15.00%	108	15.10%	30	16.00%
Liver disease	13	0.40%	10	0.50%	4	0.60%	1	0.50%
Obstructive sleep apnea	695	21.00%	409	22.00%	150	20.90%	44	23.50%
Paralysis	3	0.10%	2	0.10%	1	0.10%	0	0.00%
Peripheral vascular disease	30	0.90%	17	0.90%	6	0.80%	2	1.10%
Psychoses	46	1.40%	26	1.40%	10	1.40%	2	1.10%
Pulmonary circulation disorders	20	0.60%	11	0.60%	4	0.60%	1	0.50%
Renal failure	73	2.20%	39	2.10%	16	2.20%	4	2.10%
Rheumatoid arthritis/collagen vascular disease	93	2.80%	54	2.90%	20	2.80%	5	2.70%
Valvular heart disease	80	2.40%	45	2.40%	17	2.40%	6	3.20%

BMI: Body mass index.

Table 3 Pre-total hip arthroplasty comparison of the different study groups

BMI (kg/m2)	25-29.9 (Overweight)	30-34.9 (Stage I)	35-39.9 (Stage II)	≥40 (Stage III)	P value
Gender (percent male)	961/959 (50.0%)	445/454 (49.5%)	121/164 (42.5%)	34/36 (48.6%)
Age at the time of Arthroplasty (years)	65.8 ± 11.0	63.7 ± 11.0	62.6 ± 10.6	58.9 ± 10.2	< 0.001
Harris Hip Score	47.1 ± 12.5	44.8 ± 12.4	42.2 ± 13.1	37.7 ± 12.2	< 0.001
Weight (kilograms)	80.7 ± 9.8	94.4 ± 11.5	107.8 ± 12.8	125.9 ± 18.2	< 0.001

BMI: Body mass index.

Table 4 Pre-total knee arthroplasty comparison of the different study groups

BMI (kg/m2)	25-29.9 (Overweight)	30-34.9 (Stage I)	35-39.9 (Stage II)	≥40 (Stage III)	P value
Gender (percent male)	596/798 (42.7%)	368/593 (38.3%)	116/316 (26.8%)	33/84 (28.2%)
Age at the time of Arthroplasty (yr)	68.2 ± 9.7	65.9 ± 9.3	64.2 ± 9.2	62.8 ± 7.0	< 0.001
Hospital for Special Surgery Score	55.7 ± 13.1	54.2 ± 13.3	50.6 ± 12.9	49.3 ± 13.8	< 0.001
Weight (kg)	79.9 ± 9.9	92.9 ± 11.5	103.7 ± 13.3	119.6 ± 16.5	< 0.001

BMI: Body mass index.

Table 5 Relationships between age at total hip arthroplasty, Harris Hip Score, body mass index, stages of overweight/obesity and gender

	Age at THARegression coefficient	P value	HHSRegression Coefficient	P value
BMI	-0.178 (-0.226 to -0.13)	< 0.001	-0.201 (-0.256 to -0.146)	< 0.001
HHS	-0.217 (-0.232 to -0.202)	< 0.001
Gender	0.112 (-0.268 to 0.492)	< 0.001	-0.099 (-0.537 to 0.339)	< 0.001
Overweight	0.139 (-0.251 to 0.529)	< 0.001	0.148 (-0.301 to 0.597)	< 0.001
Stage I	-0.098 (-0.529 to 0.333)	< 0.001	-0.099 (-0.594 to 0.396)	< 0.001
Stage II	-0.110 (-0.786 to 0.566)	< 0.001	-0.125 (-0.901 to 0.651)	< 0.001
Stage III	-0.116 (-1.427 to 1.195)	< 0.001	-0.127 (-1.631 to 1.377)	< 0.001
Age at THA			-0.215 (-0.415 to -0.195)	< 0.001

BMI: Body mass index; THA: Total hip arthroplasty; HHS: Harris Hip Score.

Table 6 Relationships between age at total knee arthroplasty, Harris Hip Score, body mass index, stages of overweight/obesity and gender

	Age at TKARegression coefficient	P value	HSSRegression coefficient	P value
BMI	-0.224 (-0.263 to 0.185)	< 0.001	-0.152 (-0.208 to 0.096)	< 0.001
HSS	-0.118 (-0.132 to -0.104)	< 0.001
Gender	0.076 (-0.294 to 0.446)	< 0.001	-0.128 (-0.641 to 0.385)	< 0.001
Overweight	0.184 (-0.175 to 0.543)	< 0.001	0.115 (-0.39 to 0.62)	< 0.001
Stage I	-0.129 (-0.529 to 0.271)	< 0.001	-0.063 (-0.623 to 0.497)	< 0.001
Stage II	-0.181 (-0.715 to 0.353)	< 0.001	-0.138 (-0.885 to 0.609)	< 0.001
Stage III	-0.130 (-1.051 to 0.791)	< 0.001	-0.100 (-1.386 to 1.186)	< 0.001
Age at TKA			-0.118 (-0.144 to 0.092)	< 0.001

BMI: Body mass index; TKA: Total knee arthroplasty; HHS: Harris Hip Score.

Table 7 Distribution pattern of implanted total hip arthroplasty

BMI (kg/m2)	25-29.9total	(Overweight)%	30-34.9total	(Stage I)%	35-39.9total	(Stage II)%	≥40total	(Stage III)%
Cementless short stem	535	27.9	253	28.10	76	26.7	20	28.6
Cementless standard stem	585	30.5	297	33.00	109	38.2	27	38.6
Hybrid (cemented/cementless)	43	2.2	22	2.40	8	2.8	3	4.3
Cemented THA	757	39.4	327	36.40	92	32.3	20	28.6
Total amount	1920		899		285		70

THA: Total hip arthroplasty; BMI: Body mass index.

Table 8 Relationships between preferred prosthesis type, age at total hip arthroplasty, Harris Hip Score, body mass index, stages of overweight/obesity and gender

	Cementless short stem(Reference)		Cementless standard stem (Reference)		Hybrid (cemented/cementless) (Reference)		Cemented THA(Reference)
	Regression coefficient B	P value	Regression coefficient B	P value	Regression coefficient B	P value	Regression coefficient B	P value
Cementless short stem
BMI			-0.003 (-0.015 to 0.009)	0.826	-0.025 (-0.054 to 0.004)	0.389	0.002 (-0.013 to 0.017)	0.898
Age at THA			0.007 (0.002 to 0.012)	0.132	-0.061 (-0.075 to -0.047)	< 0.001	-0.171 (-0.179 to -0.163)	< 0.001
Gender			0.609 (0.513 to 0.705)	< 0.001	0.989 (0.737 to 1.241)	< 0.001	1.134 (1.023 to 1.245)	< 0.001
HHS			0.019 (0.015 to 0.023)	< 0.001	0.043 (0.033 to 0.053)	< 0.001	0.042 (0.037 to 0.047)	< 0.001
Cementless standard stem
BMI	0.003 (-0.117 to 0.015)	0.826			-0.023 (-0.052 to 0.006)	0.432	0.004 (-0.010 to 0.018)	0.746
Age at THA	-0.007 (-0.012 to -0.002)	0.132			-0.068 (-0.082 to -0.054)	< 0.001	-0.178 (-0.185 to -0.171)	< 0.001
Gender	-0.609 (-0.705 to -0.513)	< 0.001			0.380 (0.13 to 0.63)	0.128	0.525 (0.419 to 0.631)	< 0.001
HHS	-0.019 (-0.023 to -0.015)	< 0.001			0.024 (0.014 to 0.034)	< 0.05	0.023 (0.019 to 0.027)	< 0.001
Hybrid (cemented/cementless)
BMI	0.025 (-0.004 to 0.054)	0.389	0.023 (-0.006 to 0.052)	0.432			0.027 (-0.002 to 0.056)	0.353
Age at THA	0.061 (0.047 to 0.075)	< 0.001	0.068 (0.054 to 0.082)	< 0.001			-0.110 (-0.125 to -0.095)	< 0.001
Gender	-0.989 (-1.241 to -0.737)	< 0.001	-0.380 (-0.63 to -0.13)	0.128			0.145 (-0.105 to 0.395)	0.561
HHS	-0.043 (-0.053 to -0.033)	< 0.001	-0.024 (-0.034 to -0.014)	< 0.05			-0.001 (-0.011 to 0.009)	0.926
Cemented THA
BMI	-0.002 (-0.017 to 0.013)	0.898	-0.004 (-0.018 to 0.010)	0.746	-0.027 (-0.056 to 0.002)	0.353
Age at THA	0.171 (0.163 to 0.179)	< 0.001	0.178 (0.171 to 0.185)	< 0.001	0.110 (0.095 to 0.125)	< 0.001
Gender	-1.134 (-1.245 to -1.023)	< 0.001	-0.525 (-0.631 to -0.419)	< 0.001	-0.145 (-0.395 to 0.105)	0.561
HHS	-0.042 (-0.047 to -0.037)	< 0.001	-0.023 (-0.027 to -0.019)	< 0.001	0.001 (-0.009 to 0.011)	0.926

TKA: Total knee arthroplasty; HHS: Harris Hip Score; BMI: Body mass index.

Table 9 Distribution pattern of implanted total knee arthroplasty

BMI (kg/m2)	25-29.9total	(Overweight)percent	30-34.9total	(Stage I)percent	35-39.9total	(Stage II)percent	≥40total	(Stage III)percent
Bicondylar surface replacement	1246	89.40%	878	91.40%	403	93.30	116	99.10%
Long stem	60	4.30%	43	4.50%	22	5.00	1	0.90%
PFJ	10	0.70%	5	0.50%	3	0.70	0	0.00%
Unicondylar knee replacement	78	5.60%	35	3.60%	4	0.90	0	0.00%
Total amount	1394		961		432		117

BMI: Body mass index.

Table 10 Relationships between preferred prosthesis type, age at total hip arthroplasty, Harris Hip Score, body mass index, stages of overweight/obesity and gender

	Bicondylar surface replacement (Reference)		Long stem(Reference)		PFJ(Reference)		Unicondylar knee replacement (Reference)
	Regression coefficient B	P value	Regression coefficient B	P value	Regression coefficient B	P value	Regression coefficient B	P value
Bicondylar surface replacement
BMI			0.023 (0.001 to 0.045)	0.299	0.085 (0.023 to 0.147)	0.172	0.133 (0.104 to 0.162)	< 0.001
Age at THA			-0.046 (-0.057 to -0.035)	< 0.001	0.158 (0.131 to 0.185)	< 0.001	0.043 (0.033 to 0.053)	< 0.001
Gender			-0.097 (-0.307 to 0.113)	0.642	0.447 (-0.06 to 0.954)	0.378	-0.277 (-0.477 to -0.077)	0.167
HSS			0.070 (0.063 to 0.077)	< 0.001	-0.056 (-0.077 to -0.035)	< 0.001	-0.047 (-0.056 to -0.038)	< 0.001
Long stem
BMI	-0.023 (-0.045 to -0.001)	0.299			0.062 (-0.004 to 0.128)	0.348	0.110 (0.074 to 0.146)	< 0.05
Age at THA	0.046 (0.035 to 0.057)	< 0.001			0.204 (0.175 to 0.233)	< 0.001	0.089 (0.074 to 0.104)	< 0.001
Gender	0.097 (-0.113 to 0.307)	0.642			0.545 (-0.002 to 1.092)	0.320	-0.179 (-0.466 to 0.108)	0.532
HSS	-0.070 (-0.077 to -0.063)	< 0.001			-0.125 (-0.148 to -0.102)	< 0.001	-0.117 (-0.128 to -0.106)	< 0.001
PFJ
BMI	-0.085 (-0.147 to -0.023)	0.172	-0.062 (-0.128 to 0.004)	0.348			0.049 (-0.019 to 0.117)	0.472
Age at THA	-0.158 (-0.185 to -0.131)	< 0.001	-0.204 (-0.233 to -0.175)	< 0.001			-0.115 (-0.143 to -0.087)	< 0.001
Gender	-0.447 (-0.954 to 0.06)	0.378	-0.545 (-1.092 to 0.002)	0.320			-0.724 (-0.1262 to -0.186)	0.178
HSS	0.056 (0.035 to 0.077)	< 0.001	0.125 (0.102 to 0.148)	< 0.001			0.008 (-0.015 to 0.031)	0.711
Unicondylar knee replacement
BMI	-0.133 (-0.162 to -0.104)	< 0.001	-0.110 (-0.146 to -0.074)	< 0.05	-0.049 (-0.117 to 0.019)	0.472
Age at THA	-0.043 (-0.053 to -0.033)	< 0.001	-0.089 (-0.104 to -0.074)	< 0.001	0.115 (0.087 to 0.143)	< 0.001
Gender	0.277 (0.077 to 0.477)	0.167	0.179 (-0.108 to 0.466)	0.532	0.724 (0.186 to 1.262)	0.178
HSS	0.047 (0.038 to 0.056)	< 0.001	0.117 (0.106 to 0.128)	< 0.001	-0.008 (-0.031 to 0.015)	0.711

THA: Total hip arthroplasty; HHS: Harris Hip Score; BMI: Body mass index; PFJ: Patello-femoral joint.

Table 11 Surgical complications in total hip arthroplasty

BMI (kg/m2)	25-29.9total	(Overweight)percent	30-34.9total	(Stage I)percent	35-39.9total	(Stage II)percent	≥40total	(Stage III)percent
Femoral fracture	8	0.2%	1	0.1%
Femoral perforation	2	0.1%
Trochanteric fracture	4	0.1%			2	0.3%
Acetabular fracture					1	0.1%
Acetabular perforation	11	0.3%	6	0.3%	3	0.4%	1	0.5%
Vascular leasion	1	0.0%
Other complications	1	0.0%	2	0.1%

BMI: Body mass index.

Table 12 Surgical complications in total knee arthroplasty

BMI (kg/m2)	25-29.9total	(Overweight)percent	30-34.9total	(Stage I)percent	35-39.9total	(Stage II)percent	≥ 40total	(Stage III)percent
Femoral fracture			1	0.1%
Femoral perforation	4	0.1%	2	0.1%	2	0.3%	1	0.5%
Condylar fracture	3	0.1%	1	0.1%
Rupture of the patellar tendon					1	0.1%	1	0.5%
Vascular leasion	2	0.1%
Nerval leasion	1	0.0%
Wound healing disorders			1	0.1%
Other complications	3	0.1%	4	0.2%	2	0.3%

BMI: Body mass index.