Patient-Reported Outcomes Differentially Worsen in Patients With Greater Obesity Classes After Hip Arthroscopy

Abstract

Purpose

To explore the association between obesity classification and patient-reported outcomes (PROs) in hip arthroscopy.

Methods

This retrospective cohort study included patients who underwent hip arthroscopy and completed at least 1 preoperative and corresponding postoperative PRO—the modified Harris Hip Score (mHHS), visual analog pain scale (VAS), or Veterans RAND 12 (VR-12)—between December 2018 and August 2023. Exclusion criteria included previous ipsilateral hip surgery, incomplete or missing PROs, missing body mass index (BMI) data, follow-up <2 weeks, inflammatory arthritis, hip dysplasia, or avascular necrosis. Nonobesity was defined as BMI <30 and obesity as BMI ≥30, further classified as class I/II (BMI 30-40) or class III (BMI ≥40). Significance was set at alpha = 0.05.

Results

In total, 349 cases were included in this study. Average BMI was 25.87 and age was 34.42 years. 65% of patients were female. In total, 288 patients (82.5%) did not have obesity and 61 patients (17.5%) had obesity. In the obesity group, 3 patients (4.9%) were defined as having class III obesity. Compared with baseline, patients without obesity demonstrated significant improvements across all 4 PROs at every time point. Similarly, patients classified with class I/II obesity showed significant improvement in the VAS, HHS, and VR-12 Physical but not in the VR-12 Mental score. Patients with class III obesity did not experience any improvement in PROs after 4 weeks and had significantly worse scores compared with both patients with class I/II obesity and patients without obesity at every time point.

Conclusions

Although patients without obesity consistently demonstrated significant improvements across all 4 PROs, outcomes for patients with obesity varied depending on the severity of obesity. Patients with class I/II obesity showed intermittent improvements, with significant gains in some PROs but not all. In contrast, patients with class III obesity did not experience any significant lasting improvements in outcomes after hip arthroscopy.

Level of Evidence

Level III, retrospective cohort study.