The impact of preoperative weight loss timing on surgical outcomes in total hip arthroplasty
Abstract
Background Elevated body mass index (BMI) increases surgical complications post-total hip arthroplasty (THA). However, the effects of rapid weight loss pre-THA remain unclear. This study evaluated patients who had initial BMIs between 40 and 50, and then achieved a BMI under 35 at various intervals before their THA. Comparisons were made with consistent obese and nonobese groups to understand potential complications.Methods Using a national database, we categorized THA patients based on initial BMI and weight loss timing before the surgery. These were contrasted with those maintaining a steady BMI of 20 to 30 or 40 to 50. We monitored outcomes like periprosthetic joint infections (PJI), surgical site infections (SSI), and noninfectious revisions for 2 years postsurgery, incorporating demographic considerations. Statistical analyses utilized Chi-square tests for categorical outcomes and Student's t-tests for continuous variables.Results Among patients who had a BMI of 45 to 50, weight loss 3 to 9 months presurgery increased PJI risks at 90 days (Odds Ratios [OR]: 2.15 to 5.22, P < .001). However, weight loss a year before the surgery lowered the PJI risk (OR: 0.14 to 0.27, P < .005). Constantly obese patients faced heightened PJI risks 1 to 2 years postsurgery (OR: 1.64 to 1.95, P < .015). Regarding SSI, risks increased with weight loss 3 to 9 months before surgery, but decreased when weight loss occurred a year earlier. In the BMI 40 to 45 group, weight loss 3 to 6 months presurgery showed higher PJI and SSI at 90 days (P < .001), with obese participants consistently at greater risk.Conclusions While high BMI poses THA risks, weight loss timing plays a crucial role in postoperative complications. Weight loss closer to the surgery (0 to 9 months) can heighten risks, but shedding weight a year in advance seems beneficial. Conversely, initiating weight loss approximately a year before surgery offers potential protective effects against postoperative issues. This highlights the importance of strategic weight management guidance for patients considering THA, ensuring optimal surgical results and reducing potential adverse outcomes.
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There is supportive evidence that weight loss prior to surgery has benefits.
“There is supportive evidence supporting the benefits of weight loss prior to surgery.51,52”
From Evaluation of safety of preoperative GLP-1 receptor agonists in patients undergoing elective surgery: a systematic review, meta-analysis and meta-regression (2025) · cites this paper as [52]
Preoperative weight loss has been associated with improved intraoperative technical performance, enhanced visualisation, and reduced operative time.
“Preoperative weight loss has been associated with improved intraoperative technical performance, enhanced visualisation, and reduced operative time.52,53”
From Evaluation of safety of preoperative GLP-1 receptor agonists in patients undergoing elective surgery: a systematic review, meta-analysis and meta-regression (2025) · cites this paper as [52]
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Kamarajah, S. K., Gudiozzi, N., Findlay, J. M., Lee, M. J., Pinkney, T., & Markar, S. R. (2025) · eClinicalMedicine · doi:10.1016/j.eclinm.2025.103408 · Cited by 29 · see citing works
- Authors
- Shul, C., Hameed, D., Oster, B., Dubin, J. A., Bains, S. S., Mont, M. A., & Johnson, A. J.
- Affiliations
- University of Maryland, Baltimore (US)
- Sinai Hospital (US)
- Corresponding author
- Mont, Michael A.
- ORCID
- Venue
- The Journal of Arthroplasty
- Publisher
- Elsevier BV
- Published
- 2024-06
- Volume
- 39
- Issue
- 6
- Pages
- 1424-1431
- ISSN
- 0883-5403 (ISSN-L)
- OpenAlex
- W4392387940
- Cited by
- 20
- References
- 28
- Citations by year
- 2026: 6 · 2025: 9 · 2024: 5
- FWCI
- 8.45
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- The Journal of Arthroplasty (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Total Knee Arthroplasty Outcomes
- Health Sciences › Medicine › Surgery › Orthopedic Infections and Treatments
- Health Sciences › Medicine › Surgery › Orthopaedic implants and arthroplasty
- Keywords
- total hip arthroplasty, preoperative weight loss, body mass index, morbid obesity, periprosthetic joint infection, surgical site infection, revision arthroplasty, postoperative complications, weight management
- MeSH terms
- Adult, Aged, Female, Humans, Male, Middle Aged, Obesity, Postoperative Complications, Reoperation, Retrospective Studies, Risk Factors, Surgical Wound Infection, Time Factors, Weight Loss, Body Mass Index, Prosthesis-Related Infections, Treatment Outcome, Arthroplasty, Replacement, Hip, Preoperative Period
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