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Die endoprothetische Versorgung beim übergewichtigen Koxarthrosepatienten

Total hip arthroplasty in overweight osteoarthritis patients

Der Orthopäde volume 44, pages 523–530 (2015)Cite this article

Zusammenfassung

Hintergrund

Ein zunehmender Anteil aller hüftendoprothetisch zu versorgenden Patienten ist adipös und weist ein gegenüber normalgewichtigen Patienten geändertes Risikoprofil auf.

Ziel der Arbeit

Es soll ein Überblick zum Einfluss von Adipositas auf das Ergebnis nach primärerer Hüftendoprothetik vermittelt werden.

Material und Methoden

Recherche der aktuell verfügbaren wissenschaftlichen Literatur und Darlegung eigener epidemiologischer Untersuchungen.

Ergebnisse

Adipöse können einen für normalgewichtige Patienten vergleichbaren hohen funktionellen Nutzen nach Hüftendoprothesenversorgung erwarten. Eine hochgradige Adipositas begünstigt jedoch das Auftreten peri- und postoperativer Komplikationen, insbesondere die periprothetische Infektion und die Endoprothesenluxation und sollte präoperativ nach Möglichkeit behandelt werden.

Diskussion

Die Kenntnis adipositasassoziierter Risiken ist eine Voraussetzung für die erfolgreiche endoprothetische Versorgung übergewichtiger Koxarthrosepatienten.

Abstract

Background

An increasing number of patients scheduled for total hip arthroplasty (THA) are obese and exhibit a different risk profile from that of patients of normal weight.

Objectives

To provide an overview of the impact of obesity on the outcome of primary THA.

Materials and methods

Literature review and discussion of own epidemiological data.

Results

Obese patients can expect as much functional improvement as non-obese patients after THA. However, peri- and postoperative complication (e.g., periprosthetic infection and dislocation) rates are reported to be increased in obese THA patients.

Conclusions

The knowledge of obesity-associated risks is the prerequiste for successful THA in obese patients.

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Abbreviations

BMI:

Body Mass Index [kg/m2]

EQ-5D:

Euroquol Gesundheitsfragebogen zur Erhebung der Lebensqualität

HHS:

Harris Hip Score

MIS:

minimally invasive surgery

SF-12/36:

Short Form Gesundheitsfragebogen mit 12/36 Items

TEP:

totale Endoprothese

WOMAC:

Western Ontario and McMasters Universities Arthritis Index

Literatur

  1. Swedish Hip Arthroplasty Register. 2012

  2. 11th Annual Report of the the National Joint Registry for England, Wales and Northern Ireland. 2013

  3. Andrew JG, Palan J, Kurup HV, Gibson P, Murray DW, Beard DJ (2008) Obesity in total hip replacement. J Bone Joint Surg Br 90(4):424–429

    CAS  PubMed  Article  Google Scholar 

  4. Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V.(AWMF). S3-Leitlinie für die Chirurgie der Adipositas. 2011

  5. Bourne R, Mukhi S, Zhu N, Keresteci M, Marin M (2007) Role of obesity on the risk for total hip or knee arthroplasty. Clin Orthop Relat Res 465:185–188

    PubMed  Google Scholar 

  6. Bowditch MG, Villar RN (1999) Do obese patients bleed more? A prospective study of blood loss at total hip replacement. Ann R Coll Surg Engl 81(3):198–200

    CAS  PubMed Central  PubMed  Google Scholar 

  7. Callaghan JJ, Forest EE, Olejniczak JP, Goetz DD, Johnston RC (1998) Charnley total hip arthroplasty in patients less than fifty years old. A twenty to twenty-five-year follow-up note. J Bone Joint Surg Am 80(5):704–714

    CAS  PubMed  Google Scholar 

  8. Callanan MC, Jarrett B, Bragdon CR, Zurakowski D, Rubash HE, Freiberg AA et al (2011) The John Charnley Award: risk factors for cup malpositioning: quality improvement through a joint registry at a tertiary hospital. Clin Orthop Relat Res 469(2):319–329

    PubMed Central  PubMed  Article  Google Scholar 

  9. Changulani M, Kalairajah Y, Peel T, Field RE (2008) The relationship between obesity and the age at which hip and knee replacement is undertaken. J Bone Joint Surg Br 90(3):360–363

    CAS  PubMed  Article  Google Scholar 

  10. Chee YH, Teoh KH, Sabnis BM, Ballantyne JA, Brenkel IJ (2010) Total hip replacement in morbidly obese patients with osteoarthritis: results of a prospectively matched study. J Bone Joint Surg Br 92(8):1066–1071

    CAS  PubMed  Article  Google Scholar 

  11. de Zwaan M, Hilbert A, Herpertz S, Zipfel S, Beutel M, Gefeller O et al (2008) Weight loss maintenance in a population-based sample of German adults. Obesity (Silver Spring) 16(11):2535–2540

    Article  Google Scholar 

  12. Dienstknecht T, Luring C, Tingart M, Grifka J, Sendtner E (2013) A minimally invasive approach for total hip arthroplasty does not diminish early post-operative outcome in obese patients: a prospective, randomised trial. Int Orthop 37(6):1013–1018

    PubMed Central  PubMed  Article  Google Scholar 

  13. Dowsey MM, Choong PF (2008) Obesity is a major risk factor for prosthetic infection after primary hip arthroplasty. Clin Orthop Relat Res 466(1):153–158

    PubMed Central  PubMed  Article  Google Scholar 

  14. Elkins JM, Daniel M, Pedersen DR, Singh B, Yack HJ, Callaghan JJ et al (2013) Morbid obesity may increase dislocation in total hip patients: a biomechanical analysis. Clin Orthop Relat Res 471(3):971–980

    PubMed Central  PubMed  Article  Google Scholar 

  15. Elson LC, Barr CJ, Chandran SE, Hansen VJ, Malchau H, Kwon YM (2013) Are morbidly obese patients undergoing total hip arthroplasty at an increased risk for component malpositioning? J Arthroplasty 28(8 Suppl):41–44

    PubMed  Article  Google Scholar 

  16. Fehring TK, Odum SM, Griffin WL, Mason JB, McCoy TH (2007) The obesity epidemic: its effect on total joint arthroplasty. J Arthroplasty 22(6 Suppl 2):71–76

    PubMed  Article  Google Scholar 

  17. Felson DT (2004) Risk factors for osteoarthritis: understanding joint vulnerability. Clin Orthop Relat Res (427 Suppl):S16–S21

  18. Friedman RJ, Hess S, Berkowitz SD, Homering M (2013) Complication rates after hip or knee arthroplasty in morbidly obese patients. Clin Orthop Relat Res 471(10):3358–3366

    PubMed Central  PubMed  Article  Google Scholar 

  19. Gage MJ, Schwarzkopf R, Abrouk M, Slover JD (2014) Impact of metabolic syndrome on perioperative complication rates after total joint arthroplasty surgery. J Arthroplasty 29(9):1842–1845

    PubMed  Article  Google Scholar 

  20. Gonzalez DV, Chiu YL, Ma Y, Mazumdar M, Memtsoudis SG (2012) The metabolic syndrome in patients undergoing knee and hip arthroplasty: trends and in-hospital outcomes in the United States. J Arthroplasty 27(10):1743–1749

    Article  Google Scholar 

  21. Grant JA, Viens N, Bolognesi MP, Olson SA, Cook CE (2008) Two-year outcomes in primary THA in obese male veterans administration medical center patients. Rheumatol Int 28(11):1105–1109

    PubMed  Article  Google Scholar 

  22. Harms S, Larson R, Sahmoun AE, Beal JR (2007) Obesity increases the likelihood of total joint replacement surgery among younger adults. Int Orthop 31(1):23–26

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  23. Haverkamp D, Klinkenbijl MN, Somford MP, Albers GH, van der Vis HM (2011) Obesity in total hip arthroplasty-does it really matter? A meta-analysis. Acta Orthop 82(4):417–422

    PubMed Central  PubMed  Article  Google Scholar 

  24. Hayashi S, Nishiyama T, Fujishiro T, Hashimoto S, Kanzaki N, Nishida K et al (2012) Obese patients may have more soft tissue impingement following primary total hip arthroplasty. Int Orthop 36(12):2419–2423

    PubMed Central  PubMed  Article  Google Scholar 

  25. Hungerford MW, Schuh R, O'Reilly MP, Jones LC (2014) Outcome of minimally invasive hip replacement in obese, overweight, and nonobese patients. J Surg Orthop Adv 23(2):68–74

    PubMed  Article  Google Scholar 

  26. Ibrahim MS, Twaij H, Giebaly DE, Nizam I, Haddad FS (2013) Enhanced recovery in total hip replacement: a clinical review. Bone Joint J 95-B(12):1587–1594

    CAS  PubMed  Article  Google Scholar 

  27. Ibrahim T, Hobson S, Beiri A, Esler CN (2005) No influence of body mass index on early outcome following total hip arthroplasty. Int Orthop 29(6):359–361

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  28. Inacio MC, Kritz-Silverstein D, Raman R, Macera CA, Nichols JF, Shaffer RA et al (2014) The impact of pre-operative weight loss on incidence of surgical site infection and readmission rates after total joint arthroplasty. J Arthroplasty 29(3):458–464

    PubMed  Article  Google Scholar 

  29. Jackson MP, Sexton SA, Yeung E, Walter WL, Walter WK, Zicat BA (2009) The effect of obesity on the mid-term survival and clinical outcome of cementless total hip replacement. J Bone Joint Surg Br 91(10):1296–1300

    CAS  PubMed  Article  Google Scholar 

  30. Jones CA, Cox V, Jhangri GS, Suarez-Almazor ME (2012) Delineating the impact of obesity and its relationship on recovery after total joint arthroplasties. Osteoarthritis Cartilage 20(6):511–518

    CAS  PubMed  Article  Google Scholar 

  31. Judge A, Batra RN, Thomas GE, Beard D, Javaid MK, Murray DW et al (2014) Body mass index is not a clinically meaningful predictor of patient reported outcomes of primary hip replacement surgery: prospective cohort study. Osteoarthritis Cartilage 22(3):431–439

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  32. Kessler S, Kafer W (2007) Overweight and obesity: two predictors for worse early outcome in total hip replacement? Obesity (Silver Spring) 15(11):2840–2845

    Article  Google Scholar 

  33. Kim YH, Park JW, Kim JS (2014) Outcome of an ultrashort metaphyseal-fitting anatomic cementless stem in highly active obese and non-obese patients. Int Orthop (Epub ahead of print)

  34. Kiyama T, Kinsey TL, Mahoney OM (2013) Can squeaking with ceramic-on-ceramic hip articulations in total hip arthroplasty be avoided? J Arthroplasty 28(6):1015–1020

    PubMed  Article  Google Scholar 

  35. Koch TR, Finelli FC (2010) Postoperative metabolic and nutritional complications of bariatric surgery. Gastroenterol Clin North Am 39(1):109–124

    PubMed  Article  Google Scholar 

  36. Kremers HM, Visscher SL, Kremers WK, Naessens JM, Lewallen DG (2014) The effect of obesity on direct medical costs in total knee arthroplasty. J Bone Joint Surg Am 96(9):718–724

    PubMed  Article  Google Scholar 

  37. Kulkarni A, Jameson SS, James P, Woodcock S, Muller S, Reed MR (2011) Does bariatric surgery prior to lower limb joint replacement reduce complications? Surgeon 9(1):18–21

    CAS  PubMed  Article  Google Scholar 

  38. Lubbeke A, Stern R, Garavaglia G, Zurcher L, Hoffmeyer P (2007) Differences in outcomes of obese women and men undergoing primary total hip arthroplasty. Arthritis Rheum 57(2):327–334

    PubMed  Article  Google Scholar 

  39. Marchant MH Jr, Viens NA, Cook C, Vail TP, Bolognesi MP (2009) The impact of glycemic control and diabetes mellitus on perioperative outcomes after total joint arthroplasty. J Bone Joint Surg Am 91(7):1621–1629

    PubMed  Article  Google Scholar 

  40. Marks R, Allegrante JP (2002) Body mass indices in patients with disabling hip osteoarthritis. Arthritis Res 4(2):112–116

    PubMed Central  PubMed  Article  Google Scholar 

  41. McArthur BA, Vulcano E, Cross M, Nguyen J, la Valle AG, Salvati E (2014) Acetabular component orientation in total hip arthroplasty: the impact of obesity. Hip Int 24(3):263–269

    PubMed  Article  Google Scholar 

  42. McBride A, Flynn J, Miller G, Barnes M, Mackie S (2013) Body mass index and acetabular component position in total hip arthroplasty. ANZ J Surg 83(3):171–174

    PubMed  Article  Google Scholar 

  43. McCalden RW, Charron KD, Macdonald SJ, Bourne RB, Naudie DD (2011) Does morbid obesity affect the outcome of total hip replacement?: an analysis of 3290 THRs. J Bone Joint Surg Br 93(3):321–325

    CAS  PubMed  Article  Google Scholar 

  44. McLaughlin JR, Lee KR (2006) The outcome of total hip replacement in obese and non-obese patients at 10- to 18-years. J Bone Joint Surg Br 88(10):1286–1292

    CAS  PubMed  Article  Google Scholar 

  45. Moran M, Walmsley P, Gray A, Brenkel IJ (2005) Does body mass index affect the early outcome of primary total hip arthroplasty? J Arthroplasty 20(7):866–869

    PubMed  Article  Google Scholar 

  46. Motaghedi R, Bae JJ, Memtsoudis SG, Kim DH, Beathe JC, Paroli L et al (2014) Association of obesity with inflammation and pain after total hip arthroplasty. Clin Orthop Relat Res 472(5):1442–1448

    PubMed Central  PubMed  Article  Google Scholar 

  47. Muller M, Tohtz S, Dewey M, Springer I, Perka C (2011) Muscle trauma in primary total hip arthroplasty depending on age, BMI, and surgical approach: minimally invasive anterolateral versus modified direct lateral approach. Orthopäde 40(3):217–223

    CAS  PubMed  Article  Google Scholar 

  48. Namba RS, Paxton L, Fithian DC, Stone ML (2005) Obesity and perioperative morbidity in total hip and total knee arthroplasty patients. J Arthroplasty 20(7 Suppl 3):46–50

    PubMed  Article  Google Scholar 

  49. Namba RS, Inacio MC, Paxton EW (2012) Risk factors associated with surgical site infection in 30,491 primary total hip replacements. J Bone Joint Surg Br 94(10):1330–1338

    CAS  PubMed  Article  Google Scholar 

  50. Parvizi J, Trousdale RT, Sarr MG (2000) Total joint arthroplasty in patients surgically treated for morbid obesity. J Arthroplasty 15(8):1003–1008

  51. Patel VP, Walsh M, Sehgal B, Preston C, DeWal H, Di Cesare PE (2007) Factors associated with prolonged wound drainage after primary total hip and knee arthroplasty. J Bone Joint Surg Am 89(1):33–38

    PubMed  Article  Google Scholar 

  52. Perka C, Labs K, Muschik M, Buttgereit F (2000) The influence of obesity on perioperative morbidity and mortality in revision total hip arthroplasty. Arch Orthop Trauma Surg 120(5–6):267–271

    CAS  PubMed  Article  Google Scholar 

  53. Pirard E, De Lint JA (2007) Anteversion of the acetabular component in obese patients. Hip Int 17(2):99–103

    CAS  PubMed  Google Scholar 

  54. Rajgopal R, Martin R, Howard JL, Somerville L, Macdonald SJ, Bourne R (2013) Outcomes and complications of total hip replacement in super-obese patients. Bone Joint J 95-B(6):758–763

    CAS  PubMed  Article  Google Scholar 

  55. Sadr AO, Bellocco R, Eriksson K, Adami J (2006) The impact of tobacco use and body mass index on the length of stay in hospital and the risk of post-operative complications among patients undergoing total hip replacement. J Bone Joint Surg Br 88(10):1316–1320

    Google Scholar 

  56. Schwarzkopf R, Thompson SL, Adwar SJ, Liublinska V, Slover JD (2012) Postoperative complication rates in the „super-obese“ hip and knee arthroplasty population. J Arthroplasty 27(3):397–401

    PubMed  Article  Google Scholar 

  57. Severson EP, Singh JA, Browne JA, Trousdale RT, Sarr MG, Lewallen DG (2012) Total knee arthroplasty in morbidly obese patients treated with bariatric surgery: a comparative study. J Arthroplasty 27(9):1696–1700

    PubMed Central  PubMed  Article  Google Scholar 

  58. Smith DM, Oliver CH, Ryder CT, Stinchfield FE (1975) Complications of Austin Moore arthroplasty. Their incidence and relationship to potential predisposing factors. J Bone Joint Surg Am 57(1):31–33

    CAS  PubMed  Google Scholar 

  59. Smith TO, Blake V, Hing CB (2011) Minimally invasive versus conventional exposure for total hip arthroplasty: a systematic review and meta-analysis of clinical and radiological outcomes. Int Orthop 35(2):173–184

    PubMed Central  PubMed  Article  Google Scholar 

  60. Stein EM, Carrelli A, Young P, Bucovsky M, Zhang C, Schrope B et al (2013) Bariatric surgery results in cortical bone loss. J Clin Endocrinol Metab 98(2):541–549

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  61. Stickles B, Phillips L, Brox WT, Owens B, Lanzer WL (2001) Defining the relationship between obesity and total joint arthroplasty. Obes Res 9(3):219–223

    CAS  PubMed  Article  Google Scholar 

  62. Stiehler M, Zobel F, Hannemann F, Schmitt J, Lutzner J, Kirschner S et al (2014) Complications of metal-on-metal tribological pairing. Orthopade 43(1):79–91

    CAS  PubMed  Article  Google Scholar 

  63. Strauss RJ, Wise L (1978) Operative risks of obesity. Surg Gynecol Obstet 146(2):286–291

    CAS  PubMed  Google Scholar 

  64. Sturmer T, Dreinhofer K, Grober-Gratz D, Brenner H, Dieppe P, Puhl W et al (2005) Differences in the views of orthopaedic surgeons and referring practitioners on the determinants of outcome after total hip replacement. J Bone Joint Surg Br 87(10):1416–1419

    CAS  PubMed  Article  Google Scholar 

  65. Tai SM, Imbuldeniya AM, Munir S, Walter WL, Walter WK, Zicat BA (2014) The effect of obesity on the clinical, functional and radiological outcome of cementless total hip replacement: a case-matched study with a minimum 10-year follow-up. J Arthroplasty 29(9):1758–1762

    PubMed  Article  Google Scholar 

  66. Todkar M (2008) Obesity does not necessarily affect the accuracy of acetabular cup implantation in total hip replacement. Acta Orthop Belg 74(2):206–209

    PubMed  Google Scholar 

  67. Tsukada S, Wakui M (2010) Decreased accuracy of acetabular cup placement for imageless navigation in obese patients. J Orthop Sci 15(6):758–763

    PubMed  Article  Google Scholar 

  68. von Roth P, Olivier M, Preininger B, Perka C, Hube R (2011) BMI and gender do not influence surgical accuracy during minimally invasive total hip arthroplasty. Hip Int 21(6):688–693

    Article  Google Scholar 

  69. Wendelboe AM, Hegmann KT, Biggs JJ, Cox CM, Portmann AJ, Gildea JH et al (2003) Relationships between body mass indices and surgical replacements of knee and hip joints. Am J Prev Med 25(4):290–295

    PubMed  Article  Google Scholar 

  70. Widmer KH (2007) Containment versus impingement: finding a compromise for cup placement in total hip arthroplasty. Int Orthop 31(Suppl 1):S29–S33

    PubMed  Article  Google Scholar 

  71. World Health Organization (2014) Obesity and overweight, Fact sheet No. 311

  72. World Health Organization (2000) Obesity: preventing and managing the global epidemic. Report of a WHO Consultation

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Danksagung

Die Autoren danken Prof. Dr. Torsten Schäfer, Heike Voigt und Brit Bretfeldt für die Unterstützung hinsichtlich Studiendesign, Datenerhebung und -analyse sowie Ergebnisinterpretation klinischer Nachuntersuchungen im Rahmen des Dresdner Hüftregisters. Das Dresdner Hüftregister wurde von der Deutschen Arthrosehilfe e. V. unterstützt. Dr. Maik Stiehler hat Drittmittel vom Bundesministerium für Bildung und Forschung erhalten.

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  1. UniversitätsCentrum für Orthopädie & Unfallchirurgie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland

    M. Stiehler Ph.D, J. Goronzy & K.-P. Günther

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  1. M. Stiehler Ph.D
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Correspondence to M. Stiehler Ph.D.

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Die erwähnten Studien im Rahmen des Dresdner Hüftregisters erfolgten in Übereinstimmung mit der Deklaration vonHelsinki und entsprechender Genehmigung durch die zuständige Ethikkommission.

Interessenkonflikt

M. Stiehler hat Drittmittel von der Firma Zimmer erhalten. K.‐P. Günther hat finanzielle Unterstützung für Forschungsprojekte von den Firmen Zimmer, Aesculap und Waldemar Link erhalten. J. Goronzy gibt an, dass kein Interessenkonflikt besteht.

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Stiehler, M., Goronzy, J. & Günther, KP. Die endoprothetische Versorgung beim übergewichtigen Koxarthrosepatienten. Orthopäde 44, 523–530 (2015). https://doi.org/10.1007/s00132-015-3094-z

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Schlüsselwörter

  • Adipositas
  • Komplikationen
  • Endoprothese
  • Hüftgelenk
  • Kompletter Gelenkersatz

Keywords

  • Complications
  • Hip
  • Obesity
  • Total joint replacement