Do the Ten-Year Functional Outcomes and Revision Rates of Total Hip Arthroplasty in Obese and Morbidly Obese Patients Justify Restricting Their Access to Surgery?
Bibliographic record
Abstract
BACKGROUND: A prospective observational study with retrospective analysis of the data was carried out on 8,089 patients who underwent total hip arthroplasty (THA) at a single elective center between January 1, 2006, and November 30, 2022. Our aim was to examine whether obesity and morbid obesity have an effect on ten-year clinical outcomes and revision rates. METHODS: The patients were divided into three groups: nonobese (body mass index [BMI] < 30), obese (BMI 30 to < 40), and morbidly obese (BMI ≥ 40). Our primary outcomes were the mean change in Oxford Hip Score and Western Ontario and McMaster's Universities Osteoarthritis Index up to 10 years to assess the clinical benefit of surgery. The secondary outcomes measured were the rate of revisions up to 10 years, rate/100 component years, time between primary THA and revision, reasons for revision (aseptic loosening, deep infection, dislocation, fractured femur), mean skin-to-skin time, American Society of Anesthesiologist Classification, and the 90-day mortality rate. The BMI data were not available for 1,130 patients (13.97%). RESULTS: There was no difference in the absolute at 10 years and mean change in Oxford Hip Score and Western Ontario and McMaster's Universities Osteoarthritis Index up to 10 years between the groups. There was no difference in the absolute revision rate between the groups, although the obese and morbidly obese groups did have a higher rate of revision/100 component years and can expect a shorter time interval between THA and revision surgery compared to the nonobese groups. We did not find any significant association between obesity and the reasons for revision surgery, with the exception of fractured femur in the nonobese group. CONCLUSIONS: The ten-year functional outcomes and revision rates of THA do not justify restricting access to surgery on the basis of BMI.
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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 | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 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".