Revision Rates and Functional Outcome Scores for Severely, Morbidly, and Super-Obese Patients Undergoing Primary Total Hip Arthroplasty
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.015 | 0.043 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.010 | 0.024 |
| Bibliometrics | 0.009 | 0.008 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".