The obesity epidemic is a growing problem and must be considered with the projected increased demand for total hip arthroplasty (THA). Previous studies have reported increased complication rates after THA in the obese population, which has led to hesitation in offering surgery to this population. Moreover, some insurers are denying coverage for morbidly obese patients. While many consider obesity a “modifiable” risk factor, very few patients with advanced osteoarthritis have successfully lost substantial weight. The experience of centers that utilize systematic preoperative risk stratification tools and standardized postoperative total joint pathways may be underrepresented in prior studies. The aim of this study is to describe one surgeon's experience performing THA in morbidly and super-obese patient populations using an institutional preoperative Risk Stratification Tool (RST) and total joints pathway. We conducted a retrospective review of patients undergoing primary THA between May 2014 and December 2017 performed by a single surgeon at a tertiary care referral center. All patients were assessed preoperatively using an institutional RST and had a minimum of 90-day postoperative follow up. Patients were stratified by body mass index (BMI, kg/m2): non-obese (BMI < 30), obese (30–34), severely obese (35–39), morbidly obese (40–44), and super-obese (≥ 45). Primary outcomes were inpatient and 90-day complications. Continuous and binary parameters were analyzed by Kruskal-Wallis and Fisher exact tests. Logistic regression was additionally utilized to evaluate outcomes by BMI cohort.Introduction
Methods
To evaluate the effectiveness of an institutionally developed
algorithm for evaluation and diagnosis of prosthetic joint injection
and to determine the impact of this protocol on overall hospital
re-admissions.p We retrospectively evaluated 2685 total hip arthroplasty (THA)
and total knee arthroplasty (TKA) patients prior to (1263) and following
(1422) the introduction of an infection detection protocol. The
protocol used conservative thresholds for C-reactive protein to
direct the medical attendant to aspirate the joint. The protocol
incorporated a clear set of laboratory and clinical criteria that
allowed a patient to be discharged home if all were met. Patients were
included if they presented to our emergency department within 120
days post-operatively with concerns for swelling, pain or infection
and were excluded if they had an unambiguous infection or if their
chief complaint was non-orthopaedic in nature.Aims
Patients and Methods
