--- title: "Complications by BMI in total hip arthroplasty. | Sutter Health" description: "A greater rate of surgical complications, in number and severity, occurs with the morbidly obese undergoing direct anterior approach total hip arthroplasty." url: "https://www.sutterhealth.org/research/publications/complications-by-bmi-in-total-hip-arthroplasty-1055312759" --- 1. [Home](https://www.sutterhealth.org/) / 2. [Research](https://www.sutterhealth.org/research) / 3. [Research publications](https://www.sutterhealth.org/research/publications) / 4. Complications by BMI in total hip arthroplasty. # Perioperative complications stratified by body mass index for the direct anterior approach to total hip arthroplasty. Hartford JM, Graw BP, & Frosch DL. _J Arthroplasty. pii: S0883-5403(20)30348-X. doi: 10.1016/j.arth.2020.04.018. \[Epub ahead of print\]_ 2020-04-11 ## Abstract Background: Previous studies have addressed the increased risk of perioperative complications in the obese and morbidly obese populations undergoing total hip arthroplasty. Over the last 15 years, the direct anterior approach has increased in popularity. The purpose of this study is to compare the 90-day perioperative complication rate of total hip arthroplasty performed through the direct anterior approach stratified by body mass index (BMI). Methods: Perioperative complications both intraoperative and up to 90 days postoperative were identified in a case series of 1808 primary total hip arthroplasties performed through a direct anterior approach. The patients were stratified according to BMI. Demographics of age, side, sex, and American Society of Anesthesiologists score were recorded. Medical and surgical complications including National Surgical Quality Improvement Program complications, length of stay, reoperation rate, readmission rate, and length of operation were recorded. Bivariate analysis and analysis of variance were performed. Results: Morbidly obese patients (BMI > 40) demonstrated increased American Society of Anesthesiologists scores, increased surgical times with statistically significant increase in number of patients with surgical complications, National Surgical Quality Improvement Program complications, deep infection, and wound breakdown. Grading the severity of complications also demonstrated the morbidly obese had a higher risk of experiencing more severe complications. Underweight patients (BMI < 18.5) demonstrated a statistically significant readmission rate. Conclusion: In stratifying patients undergoing the direct anterior approach for total hip arthroplasty by BMI, a greater rate of surgical complications both in number and in severity occurs with the morbidly obese undergoing total hip arthroplasty through a direct anterior approach. [PubMed abstract](https://pubmed.ncbi.nlm.nih.gov/32389402/) ## Research topics - [Musculoskeletal Disorders](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Musculoskeletal+Disorders%5C%22%22) - [Obesity](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Obesity%5C%22%22) ## Related publications [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) - Publication ### [Should sports injuries and surgeries be "POLICED"?](https://www.sutterhealth.org/research/publications/should-sports-injuries-and-surgeries-be-policed-1055312423) Saxena A. J Foot Ankle Surg. 56(5):916. doi: 10.1053/j.jfas.2017.06.012. 2017 Sep 01 - Publication ### [High revision and reoperation rates using the Agility™ Total Ankle System.](https://www.sutterhealth.org/research/publications/high-rev-reop-rates-agility-total-ankle-syst-1055312437) Criswell BJ, Douglas K, Naik R, Thomson AB. Clin Orthop Relat Res. 470(7):1980-6. doi: 10.1007/s11999-012-2242-6. Epub 2012 Jan 24. 2012 Jul 01 - Publication ### [Isolated greater trochanteric fracture and the direct anterior approach using a fracture table.](https://www.sutterhealth.org/research/publications/trochanteric-fx-and-anterior-approach-with-fx-table-1055312306) Hartford JM, Graw BP, Knowles SB, Frosch DL. J Arthroplasty. pii: S0883-5403(18)30199-2. doi: 10.1016/j.arth.2018.02.051. \[Epub ahead of print\] 2018 Feb 21 - Publication ### [DPM foot and ankle fellowships.](https://www.sutterhealth.org/research/publications/dpm-foot-and-ankle-fellowships-1055312316) McAlister JE, Hyer CF, Miller JM, Rush S, Saxena A, Steinberg JS, Weil L Jr. Foot Ankle Spec. 6(5):356-63. doi: 10.1177/1938640013500767. Epub 2013 Aug 22.Send to: 2013 Oct 01 - Publication ### [Ankle joint contact loads and displacement with progressive syndesmotic injury.](https://www.sutterhealth.org/research/publications/ankle-joint-contact-loads-prog-syndesmotic-injury-1055312416) Hunt KJ, Goeb Y, Behn AW, Criswell B, Chou L. Foot Ankle Int. 36(9):1095-103. doi: 10.1177/1071100715583456. Epub 2015 May 6. 2015 Sep 01 [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) ```json {"@context":"https://schema.org","@type":"MedicalOrganization","name":"Sutter Health","@id":"https://www.sutterhealth.org/#medicalorganization","url":"https://www.sutterhealth.org","logo":"https://www.sutterhealth.org/static/images/sutter-health-logo.svg","address":{"@type":"PostalAddress","streetAddress":"2200 River Plaza Drive","addressLocality":"Sacramento","addressRegion":"CA","postalCode":"95833","addressCountry":"US"},"areaServed":{"@type":"AdministrativeArea","name":"California"},"sameAs":["https://www.facebook.com/SutterHealth","https://www.instagram.com/sutterhealth/","https://x.com/SutterHealth","https://www.youtube.com/sutterhealth","https://www.linkedin.com/company/sutter-health","https://en.wikipedia.org/wiki/Sutter_Health"]} ``` ```json {"@context":"https://schema.org","@type":"BreadcrumbList","@id":"https://www.sutterhealth.org/research/publications/complications-by-bmi-in-total-hip-arthroplasty-1055312759#breadcrumblist","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https://www.sutterhealth.org/"},{"@type":"ListItem","position":2,"name":"Research","item":"https://www.sutterhealth.org/research"},{"@type":"ListItem","position":3,"name":"Research publications","item":"https://www.sutterhealth.org/research/publications"},{"@type":"ListItem","position":4,"name":"Complications by BMI in total hip arthroplasty."}]} ``` ```json {"@context":"https://schema.org","@type":"MedicalScholarlyArticle","@id":"https://www.sutterhealth.org/research/publications/complications-by-bmi-in-total-hip-arthroplasty-1055312759#medicalscholarlyarticle","name":"Perioperative complications stratified by body mass index for the direct anterior approach to total hip arthroplasty.","headline":"Complications by BMI in total hip arthroplasty.","abstract":"Background: Previous studies have addressed the increased risk of perioperative complications in the obese and morbidly obese populations undergoing total hip arthroplasty. Over the last 15 years, the direct anterior approach has increased in popularity. The purpose of this study is to compare the 90-day perioperative complication rate of total hip arthroplasty performed through the direct anterior approach stratified by body mass index (BMI). Methods: Perioperative complications both intraoperative and up to 90 days postoperative were identified in a case series of 1808 primary total hip arthroplasties performed through a direct anterior approach. The patients were stratified according to BMI. Demographics of age, side, sex, and American Society of Anesthesiologists score were recorded. Medical and surgical complications including National Surgical Quality Improvement Program complications, length of stay, reoperation rate, readmission rate, and length of operation were recorded. Bivariate analysis and analysis of variance were performed. Results: Morbidly obese patients (BMI > 40) demonstrated increased American Society of Anesthesiologists scores, increased surgical times with statistically significant increase in number of patients with surgical complications, National Surgical Quality Improvement Program complications, deep infection, and wound breakdown. Grading the severity of complications also demonstrated the morbidly obese had a higher risk of experiencing more severe complications. Underweight patients (BMI \u003c 18.5) demonstrated a statistically significant readmission rate. Conclusion: In stratifying patients undergoing the direct anterior approach for total hip arthroplasty by BMI, a greater rate of surgical complications both in number and in severity occurs with the morbidly obese undergoing total hip arthroplasty through a direct anterior approach.","description":"A greater rate of surgical complications, in number and severity, occurs with the morbidly obese undergoing direct anterior approach total hip arthroplasty.","keywords":["Musculoskeletal Disorders","Obesity"],"datePublished":"2020-04-11","url":"https://www.sutterhealth.org/research/publications/complications-by-bmi-in-total-hip-arthroplasty-1055312759","inLanguage":"en-US","identifier":[{"@type":"PropertyValue","propertyID":"PMID","value":"32389402"},{"@type":"PropertyValue","propertyID":"DOI","value":"10.1016/j.arth.2020.04.018"}],"sameAs":["https://pubmed.ncbi.nlm.nih.gov/32389402/","https://doi.org/10.1016/j.arth.2020.04.018"],"isPartOf":{"@type":"Periodical","name":"J Arthroplasty"},"author":[{"@type":"Person","name":"Hartford JM"},{"@type":"Person","name":"Graw BP"},{"@type":"Person","name":"Frosch DL"}],"sourceOrganization":{"@type":"MedicalOrganization","name":"Palo Alto Medical Foundation Research Institute"},"about":[{"@type":"DefinedTerm","name":"Musculoskeletal Disorders","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Musculoskeletal+Disorders%22%5D%7D%5D&verticalKey=research_publication"},{"@type":"DefinedTerm","name":"Obesity","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Obesity%22%5D%7D%5D&verticalKey=research_publication"}],"mainEntityOfPage":{"@type":"WebPage","@id":"https://www.sutterhealth.org/research/publications/complications-by-bmi-in-total-hip-arthroplasty-1055312759","breadcrumb":{"@id":"https://www.sutterhealth.org/research/publications/complications-by-bmi-in-total-hip-arthroplasty-1055312759#breadcrumblist"}}} ```