EARLY OUTCOMES OF OBESE PATIENTS UNDERGOING TOTAL HIP ARTHROPLASTY: COMPARISON OF ANTERIOR AND POSTERIOR APPROACHES

M. W. Zawadsky; W. Zelenty; E. Windsor; R. Verstraete; B. Bodendorfer

doi:10.1302/1358-992X.2019.5.083

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General Orthopaedics

EARLY OUTCOMES OF OBESE PATIENTS UNDERGOING TOTAL HIP ARTHROPLASTY: COMPARISON OF ANTERIOR AND POSTERIOR APPROACHES

International Society for Technology in Arthroplasty (ISTA) 31st Annual Congress, London, England, October 2018. Part 2.

M. W. Zawadsky
W. Zelenty
E. Windsor
R. Verstraete
B. Bodendorfer

EARLY OUTCOMES OF OBESE PATIENTS UNDERGOING TOTAL HIP ARTHROPLASTY: COMPARISON OF ANTERIOR AND POSTERIOR APPROACHES

Zawadsky MW, Zelenty W, Windsor E, Verstraete R, Bodendorfer B. EARLY OUTCOMES OF OBESE PATIENTS UNDERGOING TOTAL HIP ARTHROPLASTY: COMPARISON OF ANTERIOR AND POSTERIOR APPROACHES. Orthop Procs. 2019;101-B(SUPP_5):83-83. doi:10.1302/1358-992X.2019.5.083

Zawadsky, M. W., et al. “EARLY OUTCOMES OF OBESE PATIENTS UNDERGOING TOTAL HIP ARTHROPLASTY: COMPARISON OF ANTERIOR AND POSTERIOR APPROACHES.” Orthopaedic Proceedings, vol. 101-B, no. SUPP_5, 2019, pp. 83-83., https://doi.org/10.1302/1358-992X.2019.5.083

Zawadsky, M. W., Zelenty, W., Windsor, E., Verstraete, R., & Bodendorfer, B. (2019). EARLY OUTCOMES OF OBESE PATIENTS UNDERGOING TOTAL HIP ARTHROPLASTY: COMPARISON OF ANTERIOR AND POSTERIOR APPROACHES. Orthopaedic Proceedings, 101-B(SUPP_5), 83-83. https://doi.org/10.1302/1358-992X.2019.5.083

Zawadsky, M. W., Zelenty, W., Windsor, E., Verstraete, R. and Bodendorfer, B. (2019) “EARLY OUTCOMES OF OBESE PATIENTS UNDERGOING TOTAL HIP ARTHROPLASTY: COMPARISON OF ANTERIOR AND POSTERIOR APPROACHES.” Orthopaedic Proceedings, 101-B(SUPP_5), pp. 83-83. Available at: https://doi.org/10.1302/1358-992X.2019.5.083

Zawadsky, M. W., W. Zelenty, E. Windsor, R. Verstraete, and B. Bodendorfer. “EARLY OUTCOMES OF OBESE PATIENTS UNDERGOING TOTAL HIP ARTHROPLASTY: COMPARISON OF ANTERIOR AND POSTERIOR APPROACHES.” Orthopaedic Proceedings 101-B, no. SUPP_5 (2019): 83-83. https://doi.org/10.1302/1358-992X.2019.5.083

Zawadsky MW, Zelenty W, Windsor E, Verstraete R, Bodendorfer B. EARLY OUTCOMES OF OBESE PATIENTS UNDERGOING TOTAL HIP ARTHROPLASTY: COMPARISON OF ANTERIOR AND POSTERIOR APPROACHES. Orthop Procs. 2019 Apr 1;101-B(SUPP_5):83-83. https://doi.org/10.1302/1358-992X.2019.5.083

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Abstract

BACKGROUND

The obesity crisis in the United States has caused a significant increase of hip arthritis. Surgical complication rates are higher in this population and guidelines are being used to select patients who are acceptable candidates for surgical intervention. This retrospective study evaluated the complication rates for obese patients undergoing total hip replacement compared to non-obese patients as defined by the World Health Organization (WHO). Additionally, we compared complication rates of the direct anterior approach (ATHA) versus the posterior approach (PTHA) in a consecutive group of patients using similar protocols.

METHODS

This study is an IRB approved retrospective review of 210 patients undergoing ATHA and 201 patients undergoing PTHA during the same time period by 2 experienced, high-volume total joint surgeons. Non-obese patients were compared to obese patients using WHO body mass index (BMI) classification. Minor and major complications were reviewed as well as surgical time, length of stay, disposition, and short-term outcome measures (including pain scores, narcotic use, and assistive device use).

RESULTS

The non-obese cohort (BMI < 30) had lower complication rates (2.8% major, 4.4% minor) when compared to the obese cohort (8.7% major, 9.9% minor). Major complications by obese class were as follows: Class I 8.6%, Class II 7.1% and Class III 11.5%. The non-obese ATHA cohort had lower complication rates (0.8% major, 5.0% minor) compared to the PTHA cohort (5.0% major, 6.7% minor). ATHA obese patients had 6.3% major and 9.9% minor complication rates, compared to 11.1% major and 10.0% minor complication rates in PTHA. Lastly, the evaluation of short term outcomes showed more favorable results for ATHA compared to PTHA for both obese and non-obese patients.

CONCLUSION

Obesity was associated with an increased risk of complications and less favorable short-term outcomes following THA. Direct anterior THA was also associated with lower complication rates and more favorable short-term outcomes.

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