Patterns and predictors of weight change before and after total hip arthroplasty in Class 2 and 3 obese patients

Published:January 11, 2022DOI:https://doi.org/10.1016/j.arth.2022.01.009

      Highlights

      • Majority of WHO Class 2 and 3 obese patients undergoing THA maintained BMI peri-operatively.
      • Class 3 obese patients less likely to gain weight than Class 2 patients pre-operatively.
      • Primary predictor of post-operative weight gain was pre-operative weight loss.
      • Weight gain pre- and post-operatively not associated with worse clinical outcomes.

      Abstract

      Introduction

      This study aimed to better understand BMI change patterns and factors associated with BMI change before and after total hip arthroplasty (THA) in Class 2 and 3 obese patients, and assess if pre- or post-operative BMI change affects post-operative clinical outcomes.

      Methods

      We retrospectively reviewed World Health Organization Class 2 and 3 obese patients (BMI>35.0 at surgery) who underwent THA at a tertiary medical center from 2010-2020. BMI was recorded at one year pre-operatively (mean 11.6 months), and at most recent post-operative visit (mean 29.0 months). Baseline demographics and post-operative clinical outcomes were recorded.

      Results

      We reviewed 436 THAs with a mean age of 59.9 (11.5) years. Leading up to surgery 55.5% had unchanged BMI, and post-operatively 48.2% had unchanged BMI. Multivariate logistic regression revealed those who lost BMI pre-operatively were more likely to gain BMI post-operatively (OR:3.28,CI:1.83-5.97,p=0.005), but those who gained >5% BMI pre-operatively had no association with BMI change post-operatively. Those in a higher BMI class pre-operatively were less likely to gain BMI pre-operatively (Class 3 obese patients: OR:0.001,CI:00002-0.004,p<0.001). African American patients were more likely to gain BMI pre-operatively (OR:2.32,CI:1.16-4.66,p=0.017). We did not detect an association between BMI change and post-operative clinical outcomes.

      Conclusions

      In WHO Class 2 or 3 obese patients, most maintained BMI between their first pre-operative and final post-operative visit. Pre-operatively, Class 3 obese patients were less likely to gain weight than Class 2 obese patients. The primary predictor of post-operative weight gain was pre-operative weight loss. Weight change pre- and post-operatively were not associated with worse clinical outcomes.

      Keywords

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