No Difference in Outcomes, Complications, or Revision Rate for Obese vs. Nonobese Patients Following Hip Resurfacing Arthroplasty: A Systematic Review and Meta-Analysis.

Abstract

Background: Hip resurfacing arthroplasty (HRA) offers numerous benefits over total hip replacements such as increased preservation of natural bone, improved range of motion, and lower dislocation risks. However, patient selection is crucial, with factors such as bone quality, activity level, and body mass index (BMI) playing significant roles. Obesity in particular poses challenges, potentially increasing mechanical load on the joint, complicating surgical techniques, and affecting both immediate and long-term outcomes. The aim of this systematic review was to evaluate outcomes of HRA in obese vs. nonobese patients to determine if obesity should be considered a contraindication to HRA or if similar treatment approaches can be applied.

Methods: A literature search was conducted using PubMed, Embase, and Scopus databases with specific search terms related to HRA and obesity. Articles were screened by title and abstract, followed by full-text review. Data extraction focused on demographic and study variables such as sex, age, BMI, complication and revision rates, and patient-reported outcomes. A meta-analysis was performed using a random-effects model to compare University of California Los Angeles (UCLA) scores, Harris hip scores, complication rates, and revision rates between obese and nonobese patients, with significance set at p < 0.05.

Results: From an initial pool of 39 articles, 4 met inclusion criteria, encompassing 1,385 patients. Analysis revealed a pooled mean age of 50.92 years and a complication rate of 9.83% in obese vs. 4.7% in nonobese patients. Revision rates were 1.15% for obese and 3.70% for nonobese patients. The difference in postoperative UCLA scores, complication rates, and revision rates were deemed not statistically significant.

Conclusion: The comparability in patient-reported outcomes, complication rates, and revision rates between obese and nonobese cohorts suggests that although heightened vigilance and tailored approaches may be warranted in obese patients, obesity alone should not preclude patients from undergoing HRA. These findings advocate for a more nuanced approach to patient selection, emphasizing individualized assessment over generalized BMI cutoffs. Future HRA research should focus on long-term follow-up and larger cohort studies to further validate these results.

Level of evidence: Level III, systematic review of Level II and III studies. See Instructions for Authors for a complete description of levels of evidence.