Body mass index is not a clinically meaningful predictor of patient reported outcomes of primary hip replacement surgery: prospective cohort study

• Published in: Osteoarthritis and cartilage Vol. 22; no. 3; pp. 431 - 439
• Main Authors: Judge, A, Batra, R.N, Thomas, G.E, Beard, D, Javaid, M.K, Murray, D.W, Dieppe, P.A, Dreinhoefer, K.E, Peter-Guenther, K, Field, R, Cooper, C, Arden, N.K
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.03.2014
• Subjects: Aged; Aged, 80 and over; Arthroplasty, Replacement, Hip - statistics & numerical data; Body Mass Index; Decision making; Epidemiology; Female; Hip replacement; Humans; Male; Middle Aged; Osteoarthritis; Osteoarthritis, Hip - surgery; Pain - rehabilitation; Patient Outcome Assessment; Patient reported outcome; Patient Satisfaction; Postoperative Period; Prospective Studies; Quality of Life; Rheumatology; Risk Factors; Surveys and Questionnaires; Treatment Outcome; Body mass index; Patient reported outcome; Hip replacement; Decision making; Epidemiology; Osteoarthritis
• ISSN: 1063-4584; 1522-9653
• DOI: 10.1016/j.joca.2013.12.018

Summary Objectives To describe whether body mass index (BMI) is a clinically meaningful predictor of patient reported outcomes following primary total hip replacement (THR) surgery. Design Combined data from prospective cohort studies. We obtained information from four cohorts of patients receiving primary THR for osteoarthritis: Exeter Primary Outcomes Study (EPOS) ( n  = 1431); EUROHIP ( n  = 1327); Elective Orthopaedic Centre ( n  = 2832); and St. Helier ( n  = 787). The exposure of interest was pre-operative BMI. Confounding variables included: age, sex, SF-36 mental health, comorbidities, fixed flexion, analgesic use, college education, OA in other joints, expectation of less pain, radiographic K&L grade, ASA grade, years of hip pain. The primary outcome was the Oxford Hip Score (OHS). Regression models describe the association of BMI on outcome adjusting for all confounders. Results For a 5-unit increase in BMI, the attained 12-month OHS decreases by 0.78 points 95%CI (0.27–1.28), P -value 0.001. Compared to people of normal BMI (20–25), those in the obese class II (BMI 35–40) would have a 12-month OHS that is 2.34 points lower. Although statistically significant this effect is small and not clinically meaningful in contrast to the substantial change in OHS seen across all BMI groupings. In obese class II patients achieved a 22.2 point change in OHS following surgery. Conclusions Patients achieved substantial change in OHS after THR across all BMI categories, which greatly outweighs the small difference in attained post-operative score. The findings suggest BMI should not present a barrier to access THR in terms of PROMs.