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Study finds obese women have particularly high risk for post-THA complications

Obese women had a 16.1 adjusted incidence rate ratio for infection compared with nonobese women.

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Obesity significantly increases the risk of infection after total hip arthroplasty, a prospective study found. In particular, obese women had a "substantially increased" infection rate compared to nonobese women, the study authors noted.

Anne Lübbeke, MD, MSc, and colleagues at Geneva University Hospital in Geneva, Switzerland, compared complication rates between obese and nonobese patients who underwent primary unilateral or bilateral total hip arthroplasty (THA) from March 1996 to July 2005. The study included data for 2,495 THAs, of which 589 were performed in obese patients, defined as having a body mass index of 30 kg/m² or greater.

The results are published in the journal Arthritis Care and Research.

Lübbeke and colleagues found a higher risk for infection associated with obesity. Overall, obese patients had a 4.4 adjusted incidence rate ratio for infection. However, obese women had a substantially higher infection rate, having a 16.1 adjusted incidence rate ratio compared with nonobese women, according to the study.

Obesity appeared to have no effect on infection risk in men, the authors noted.

In addition to an increased risk for infection, obesity increased the risk for dislocation. Compared to nonobese patients, obese patients had a 2.4 adjusted incidence rate ratio for dislocation, "with a higher rate increase in obese women," the authors reported.

Five-year clinical follow-up data were available for 817 patients (818 hips), including 635 hips in nonobese patients and 183 hips in obese patients.

At 5 years, obese women, but not obese men, reported moderately lower functional outcomes and slightly less satisfaction, mostly due to a higher incidence of complications, according to a press release announcing the study results.

However, risk factors for infection known to be more frequent in obese patients, such as longer operating times and diabetes, were not related to women in the study and do not explain why women had poorer results, the release said.

Instead, the authors suggest that other factors related to gender differences, such as body fat distribution and metabolic responses, might be involved. The higher number of dislocations among obese women may also be due to lower peripheral muscle strength. Also, the lower functional outcomes may be due to additional factors, such as a higher incidence of osteoarthritis, according to the release.

"Because our study revealed increased complications among obese women, we suggest that surgeons counsel this group of patients so that they are made aware of this fact," the authors said in the study. "In addition, participating in a weight-loss program prior to surgery might be beneficial for such patients."

For more information:

• Lübbeke A, Stern R, Garavaglia G, Zurcher L, Hoffmeyer P. Differences in outcomes of obese women and men undergoing primary total hip arthroplasty. Arthritis Care Res. 2007;57:327-334.