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Study shows substantial benefits in obese patients after hip arthroscopy
Although obese patients undergoing hip arthroscopy started with lower absolute scores preoperatively and ended with lower overall absolute postoperative scores, they showed substantial benefit from surgery, demonstrating a degree of improvement similar to non-obese patients, according to study results.
Researchers assessed 680 patients undergoing primary hip arthroscopy preoperatively and postoperatively with four patient-reported outcome measures. The researchers estimated pain on the VAS and measured patient satisfaction scores. Five hundred sixty-two patients with a BMI of less than 30 kg/m2 were included in the non-obese group; 94 patients with a BMI of 30 kg/m2 to 34.9 kg/m2 were included in the class-I obese group; and 24 patients with a BMI of 35 kg/m2 to 39.9 kg/m2 were included in the class-II obese group.
Results showed a modified Harris hip score improvement from 63.41 at the preoperative assessment to 83.81 points at the 2-year follow-up visit for the non-obese group, from 54.81 to 75.95 points for the class-I obese group and of 50.81 to 80.01 points for the class-II obese group.
The researchers also found a Non-Arthritic Hip Score improvement of 60.86 to 83.62 points in the non-obese group, of 48.98 to 75.51 points for class-I obese group and of 42.36 to 72.5 points for the class-II obese group.
Within the non-obese group, the Hip Outcome Score – Activities of Daily Living improved from 66.24 to 86.24 points, and the Hip Outcome Score Sport – Specific Subscale improved from 44.01 to 73.26 points from preoperative assessment to 2-year follow-up compared with an improvement from 53.22 to 72.99 points for Activities of Daily Living and from 30.56 to 60.75 points for Sport-Specific Subscale in the class-I obese group and from 48.11 to 74.73 points for Activities of Daily Living and from 28.25 to 62.56 points for Sport-Specific Subscale in the class-II obese group.
Overall, traction time did not vary significantly between groups, according to the researchers. – by Casey Tingle
Disclosures: Gupta has no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
Perspective
Back to TopMy experience resonates with the findings of this study. In a large prospective series on arthroscopic surgical outcomes for FAI, we did not find increased BMI to be a predictor of poorer outcomes or complications.
BMI is an imperfect indirect measure of body fat. A lean but muscular build of many athletes may have a relatively high BMI, perhaps pushing them into the obese BMI category. An elderly, but portly person with low muscle mass, may have a normal or even low BMI. Gender differences also exist, where a woman may have identical BMI of a man, but greater percentage of body fat.
Nonobese may not equate to healthy. Nonobese BMI is defined as less than 30; healthy BMI is defined as 18.5 to 24.9. Although this study used a maximum of 30, the authors published a separate matched-pair controlled study comparing cohorts with BMI less than 25 and BMI greater than 30 with similar findings and conclusions.
The authors sometimes used a long arthroscope (280-mm length) to reach the hip joint. A technical pearl is to make a 2-cm portal and submerge the bridge of a standard (160-mm length) arthroscope to gain joint access in obese or muscular individuals, closing the extended portal with a single subcutaneous absorbable stitch prior to routine skin closure.
This study exemplifies the scenario where one cohort may have a lesser absolute postoperative outcome score, but similar incremental improvement. Is the former as successful as the latter? To a sedentary obese patient, I submit that the answer may be a qualified ‘Yes.’ Similar satisfaction scores support this, but there might have been a relatively higher incremental improvement in patient-reported outcome measures (PROMs) that measure primarily activities of daily living (e.g., Harris Hip Score, hip outcome score activities of daily living subset) and less relative improvement as measured on PROMS focused on athletic activities (e.g., hip outcome score sports subset).
A final thought: Obesity has almost doubled since 1980 and is the fifth leading risk for global deaths. Increased costs (42% higher) of per capita medical spending occur in obese rather than non-obese patients. Over the course of a lifetime, these costs are similar for those from smoking. So although obesity may not be a contraindication or predictor of worse or adverse outcomes from hip arthroscopy, it remains a condition with significant adverse health impact.