There are four moderate quality studies that support the existence of lower clinical scores in obese patients with mild variation in the cutoff points that define obesity (Yeung et al; BMI>30, Stevens et al; BMI>30, Davis et al; BMI >35, Judge et al; BMI >30). These results are supported by two low quality studies (McCalden et al; BMI>30, Jackson et al; BMI>30). Similar improvements in clinical scores between obese and non-obese patients are supported by one moderate quality study (Judge et al) and two low quality studies (Bennett et al; BMI>40, McCalden et al).
Similarities between obese and non-obese patient satisfaction with total hip replacement are supported by one moderate quality study (Yeung et al) and one low quality study (Villalobos et al; BMI>28).
One moderate quality study identifies a higher incidence of post-operative dislocation and superficial wound infection in obese patients (Davis et al; BMI>35). A low quality study reported a higher operative blood loss in obese patients (Bowditch et al; BMI>30).
Most of the included studies used a BMI level >30 to define obesity and for use as a comparison with lower ranges. This relatively low cutoff may mask some more dramatic differences in complications and outcomes at the higher levels, such as 40-50 and >50. In addition, BMI may not be a specific enough index to define the proportionality and distribution of adipose tissue at surgical sites.
- Aranda,Villalobos P.; Navarro-Espigares,J.L.; Hernandez-Torres,E.; Martinez-Montes,J.L.; Villalobos,M.; Arroyo-Morales,M. Body mass index as predictor of health-related quality-of-life changes after total hip arthroplasty: a cross-over study. J Arthroplasty; 2013/4: 4
- Bowditch,M.G.; Villar,R.N. Do obese patients bleed more? A prospective study of blood loss at total hip replacement. Ann R Coll Surg Engl.; 1999/5: 3
- Davis,A.M.; Wood,A.M.; Keenan,A.C.; Brenkel,I.J.; Ballantyne,J.A. Does body mass index affect clinical outcome post-operatively and at five years after primary unilateral total hip replacement performed for osteoarthritis? A multivariate analysis of prospective data. J Bone Joint Surg Br; 2011/9: 9
- Jackson,M.P.; Sexton,S.A.; Yeung,E.; Walter,W.L.; Walter,W.K.; Zicat,B.A. The effect of obesity on the mid-term survival and clinical outcome of cementless total hip replacement. J Bone Joint Surg Br; 2009/10: 10
- Judge,A.; Cooper,C.; Arden,N.K.; Williams,S.; Hobbs,N.; Dixon,D.; Gunther,K.P.; Dreinhoefer,K.; Dieppe,P.A. Pre-operative expectation predicts 12-month post-operative outcome among patients undergoing primary total hip replacement in European orthopaedic centres. Osteoarthritis Cartilage; 2011/6: 6
- McCalden,R.W.; Charron,K.D.; MacDonald,S.J.; Bourne,R.B.; Naudie,D.D. Does morbid obesity affect the outcome of total hip replacement?: an analysis of 3290 THRs. J Bone Joint Surg Br; 2011/3: 3
- Stevens,M.; Paans,N.; Wagenmakers,R.; van,Beveren J.; van Raay,J.J.; van der Meer,K.; Stewart,R.; Bulstra,S.K.; Reininga,I.H.; van,den Akker-Scheek,I The influence of overweight/obesity on patient-perceived physical functioning and health-related quality of life after primary total hip arthroplasty. Obes.Surg; 2012/4: 4
- Yeung,E.; Jackson,M.; Sexton,S.; Walter,W.; Zicat,B.; Walter,W. The effect of obesity on the outcome of hip and knee arthroplasty. Int Orthop; 2011/6: 6
- Bennett,D.; Gibson,D.; O'Brien,S.; Beverland,D.E. Hip arthroplasty in morbidly obese patients - Intra-operative and short term outcomes. HIP International; 2010/1: 1