Revision Rates and Functional Outcome Scores for Severely, Morbidly, and Super-Obese Patients Undergoing Primary Total Hip Arthroplasty
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Résumé
BACKGROUND: We performed a systematic review and meta-analysis of the literature to quantify the impact of patients with severe obesity (body mass index [BMI] > 35 kg/m), those with morbid obesity (BMI > 40 kg/m), and those with super-obesity (BMI > 50 kg/m) on revision rates and outcome scores after primary total hip arthroplasty compared with non-obese patients (BMI < 25 kg/m). METHODS: Four electronic databases were reviewed (AMED, Embase, Ovid Healthstar, and MEDLINE) from their inception to August 2016. The search strategy used combined and/or truncated keywords, including hip replacement or arthroplasty and obesity, BMI, or any synonym of the latter in the title, abstract, or manuscript text. Abstracts and full text were reviewed by 3 pairs of reviewers to identify those assessing outcomes following primary total hip arthroplasty for different BMI categories. Outcomes evaluated were revisions (total, aseptic, and septic) and change in outcome scores (preoperative to postoperative). RESULTS: The literature search identified 1,692 abstracts; 448 were included for the full-text review, and 33 were included in the meta-analysis. The morbidly obese and super-obese groups were at an increased risk for revision, especially for septic revisions, compared with the non-obese group. The severely obese group had risk ratios of 1.40 (95% confidence interval [CI], 0.97 to 2.02) for revision, 0.70 (95% CI, 0.45 to 1.10) for aseptic revision, and 3.17 (95% CI, 2.25 to 4.47) for septic revision. Morbidly obese patients had risk ratios of 2.01 (95% CI, 1.81 to 2.23) for revision, 1.40 (95% CI, 0.84 to 2.32) for aseptic revision, and 9.75 (95% CI, 3.58 to 26.59) for septic revision. Super-obese patients had risk ratios of 2.62 (95% CI, 1.68 to 4.07) for revision, 1.98 (95% CI, 0.80 to 4.94) for aseptic revision, and 7.22 (95% CI, 1.51 to 34.60) for septic revision. However, there was no significant difference (p > 0.05) in the standardized mean difference of functional outcome scores between the severely obese cohort (0.04 [95% CI, -0.02 to 0.10]), the morbidly obese cohort (0.19 [95% CI, -0.08 to 0.46]), and the super-obese cohort (-0.12 [95% CI, -0.57 to 0.33]). CONCLUSIONS: Severely obese patients, morbidly obese patients, and super-obese patients undergoing total hip arthroplasty should be counseled that, although they have comparable outcome score improvements compared with non-obese patients, they have significantly higher risks of all-cause and septic revision. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,004 | 0,001 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découle