Total Hip Arthroplasty in Patients with Obesity (Meta-analysis of Prospective Studies)

The purpose of the study is to evaluate whether patient's obesity affects on duration of total hip arthroplasty, hospital stay, blood loss volume, overall complication and death rates. Materials and methods. We searched for publications in databases PubMed, EBSCO, Cochrane, WanFang and CNKI databases. The meta-analysis included the results of 24 clinical trials in which 156.914 patients were involved-46.782 obese and 123.076 patients with normal body mass index (BMI). (Evaluation was performed using Revman 5.3 software). Results. In patients with BMI > 30, the duration of surgery was longer than in patients with normal weight. In this case, OR =-5.14 (95% CI-8.13...-2.14) min, p<0.001. The rate of postoperative dislocations: OR = 0.07 (95% CI 0.59-0.84) p<0.001. The rate of infectious complications: OR = 0.56 (95% CI 0.50-0.62) (p<0.001) and blood loss volume OR =-181.39 (95% CI-293.26...-69.52) ml, p = 0.001. Five-years postoperatively, the Harris Hip Score, reflecting the functional results, was relatively lower in obese patients than in patients with normal BMI: OR = 2.85 (95% CI 1.04-4.66), p = 0.002. However, the duration of postoperatively hospital stay was not significantly different between patients with normal and abnormal body weights: OR = 0.30, (95% CI 0.34-0.95) days, p = 0.36. Conclusion. Excessive subcutaneous fat thickness creates additional technical difficulties in the insertion of the endoprosthesis, which ultimately affects the increase in the surgery time, and blood loss. In patients with greater BMI, the frequency of postoperative dislocations and infectious complications increase, and the functional results of surgical treatment are reduced. Ultimately, obesity adversely affects the clinical efficacy of primary total hip arthroplasty.