Aims The prevalence of obesity is increasing substantially around the world. Elevated BMI increases the risk of complications following total hip arthroplasty (THA). We sought to evaluate trends in BMI and complication rates of obese patients undergoing primary THA over the last 30 years. Methods Through our institutional total joint registry, we identified 15,455 primary THAs performed for osteoarthritis from 1990 to 2019. Patients were categorized according to the World Health Organization (WHO) obesity classification and groups were trended over time. Cox proportional hazards regression analysis controlling for confounders was used to investigate the association between year of surgery and two-year risk of any reoperation, any revision, dislocation, periprosthetic joint infection (PJI), venous thromboembolism (VTE), and periprosthetic fracture. Regression was stratified by three separate groups: non-obese; WHO Class I and Class II (BMI 30 to 39 kg/m2); and WHO Class III patients (BMI ≥ 40 kg/m2). Results There was a significant increase in the proportion of all obesity classes from 1990 to 2019, and the BMI values within each WHO class significantly increased over time. Risk of any reoperation did not change over time among non-obese or WHO Class I/II patients, but increased for WHO Class III patients (hazard ratio (HR) 1.04; p = 0.044). Risk of dislocation decreased over time for non-obese (HR 0.96; p < 0.001) and WHO Class I/II (HR 0.96; p = 0.002) patients, but did not change over time for WHO Class III (HR 0.94; p = 0.073) patients. Risks of any revision and PJI did not change over time for any group. Conclusion The proportion of patients undergoing THA who are obese has increased dramatically at our institution between 1990 and 2019. Despite BMI values increasing within all WHO classes over time, two-year complication risks have remained stable or decreased in WHO Class I/II patients. However, continued efforts will be required to mitigate risks in the heaviest WHO Class III patients.

中文翻译：

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在接受全髋关节置换术的病态肥胖患者中，预防早期不良后果仍然具有挑战性。


目的 肥胖症的患病率在全球范围内大幅增加。BMI 升高会增加全髋关节置换术 （THA） 后并发症的风险。我们试图评估过去 30 年接受原发性 THA 的肥胖患者的 BMI 和并发症发生率的趋势。方法 通过我们的机构全联合登记，我们确定了 15,455 年至 1990 年因骨关节炎而进行的 2019 例原发性 THA。根据世界卫生组织 （WHO） 肥胖分类对患者进行分类，各组随时间变化的趋势。控制混杂因素的 Cox 比例风险回归分析用于调查手术年份与两年内任何再次手术、任何翻修、脱位、假体周围关节感染 （PJI）、静脉血栓栓塞 （VTE） 和假体周围骨折的风险之间的关联。回归分为三个独立的组：非肥胖;WHO I 级和 II 级（BMI 30 至 39 kg/m2）;和 WHO III 级患者 （BMI ≥ 40 kg/m2）。结果 从 1990 年到 2019 年，所有肥胖类别的比例均显著增加，每个 WHO 类别的 BMI 值随时间显著增加。非肥胖或 WHO I/II 级患者再次手术的风险不会随时间变化，但 WHO III 级患者再次手术的风险会增加 （风险比 （HR） 1.04;p = 0.044）。非肥胖 （HR 0.96;p < 0.001） 和 WHO I/II 级 （HR 0.96;p = 0.002） 患者的脱位风险随时间而降低，但 WHO III 级 （HR 0.94;p = 0.073） 患者的脱位风险随时间变化。任何组的任何修订和 PJI 的风险均未随时间而变化。结论 1990 年至 2019 年期间，我机构接受 THA 的肥胖患者比例急剧增加。 尽管所有 WHO 类别的 BMI 值都随着时间的推移而增加，但 WHO I/II 类患者的两年并发症风险保持稳定或降低。然而，需要继续努力降低最重的 WHO III 类患者的风险。