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Review of Total Hip Replacements for Obese and Geriatric Adults

Is it safe to have a total hip replacement (THR) if you are obese or older than 75 years of age? This review shows that the answer is yes for each unique group. But there are some risks and special factors the surgeon must consider.

Patients whose body mass index (BMI) is greater than 30 kg/m2 are classified as obese. They may be at increased risk for complications from anesthesia and poor wound healing. The presence of sleep apnea, diabetes, and high blood pressure are additional risk factors for poor outcome. And the durability and surface of the implant may not last as long.

The number of adults who remain active in their older years is on the rise. Therefore, the need for THR is increasing in this age group. There are concerns about blood clots, poor rehab, and falls linked with hip dislocation among the elderly. There are even more risk factors for older adults with dementia or Alzheimer's.

Studies show that careful management is needed for both the obese and the elderly patient. A multidisciplinary (team) approach is needed. Rates of infection and poor wound healing may be higher in the obese group. Mental confusion and decline in cognitive function are problems after surgery for the aging patient.

The surgeon can expect that both groups will need more help during the rehab phase. Patients and their families should be told that improved function may be less than hoped for or anticipated. Bariatric surgery for weight loss in obese patients before THR does not appear to decrease complications.

References: John E. McDonald, and Michael H. Huo. Total Hip Replacement: Unique Challenges in the Obese and Geriatric Populations. In Current Opinion in Orthopaedics. January 2008. Vol. 19. No. 1. Pp. 33-36.

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