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Wagenmakers, Jan van Beveren, Klaas van der Meer, Sjoerd K. Bulstra, Inge van den Akker-Scheek Background. Elevated body weight is associated with hip osteoarthritis (OA) and subsequently with total hip arthroplasty (THA). Patients with hip OA who are overweight often mention their restricted mobility as a factor that thwarts their attempts to be physically active and lose weight. There is some evidence that THA increases physical activity, but none for losing body weight after THA. Objective. The purpose of this study was to analyze the short-term (1-year) and long-term (4.5-year) effects of a THA on body weight. Design. This was an observational, multicenter cohort study. Methods. For the short-term effect, all patients (N618) were analyzed; for the long-term effect, a random subgroup (n100) was analyzed. Preoperative and postoperative body weight and height were self-reported. Patients were categorized according to their preoperative body mass index (BMI 25 kg/m2 normal weight, 25–30 kg/m2 overweight, 30 kg/m2 obese). Clinical relevancy was set at a minimum of 5% weight loss compared with baseline. Results. The mean age of the study group was 70 years (SD8), 74% were women, and mean preoperative body mass was 79 kg (SD14). One year after THA, a significant decrease in body weight of 1% and 3.4% occurred for the overweight and obese BMI categories, respectively. After 4.5 years, a significant decrease in body weight of 6.4% occurred for the obese BMI category. Limitations. Height and weight—and thus BMI—were self-reported. Conclusion. Patients in the overweight and obese groups showed a decrease, albeit not clinically relevant, in body weight after 1 year. After 4.5 years, a decrease that was relevant clinically was observed in the patients who were obese. It can be concluded that no clinically relevant reduction of weight occurred after THA, except in the long term for patients who were obese. N. Paans, MSc, Department of Orthopedic Surgery, University Medical Center Groningen, University of Groningen, PO Box 30 001 BB51, Groningen 9700 RB, the Netherlands. Address all correspondence to Ms Paans at: n.paans@umcg.nl. M. Stevens, PhD, Department of Orthopedic Surgery, University Medical Center Groningen, University of Groningen. R. Wagenmakers, MD, PhD, Department of Orthopedic Surgery, Amphia Hospital, Breda, the Netherlands. J. van Beveren, MD, Department of Orthopedic Surgery, Ro¨pckeZweers Hospital, Hardenberg, the Netherlands. K. van der Meer, MD, PhD, Department of General Practice, University Medical Center Groningen, University of Groningen. S.K. Bulstra, MD, PhD, Department of Orthopedic Surgery, University Medical Center Groningen, University of Groningen. I. van den Akker-Scheek, PhD, Department of Orthopedic Surgery, University Medical Center Groningen, University of Groningen, and Department of Orthopedic Surgery, Martini Hospital, Groningen, the Netherlands. [Paans N, Stevens M, Wagenmakers R, et al. Changes in body weight after total hip arthroplasty: short-term and long-term effects. Phys Ther. 2012;92:680–687.] © 2012 American Physical Therapy Association Published Ahead of Print: January 6, 2012 Accepted: December 27, 2011 Submitted: May 27, 2011 Research Report Post a Rapid Response to this article at: ptjournal.apta.org 680 f Physical Therapy Volume 92 Number 5 May 2012 Osteoarthritis (OA) of the hip is one of the most prevalent age-related chronic conditions.1,2 It causes a significant impairment in patients’ mobility and has a high impact on quality of life.3 Total hip arthroplasty (THA) has become known as a highly successful treatment for advanced OA. The incidence of patients with hip OA who need a hip arthroplasty is growing. The yearly numbers of hip arthroplasty interventions in the Netherlands for 1995–2005 increased from 13,785 to 20,715—almost 50%. A need for 51,000 hip prostheses per year is expected by the year 2030.4 One explanation for this increase is that in Western societies, including the Netherlands, older adults are growing in number as well as in age.5 Another explanation for the increase in the need for hip prostheses is the growing number of patients who are overweight,6–8 as a high BMI is considered a risk factor in the development of OA.9 Patients who are overweight and awaiting hip arthroplasty are advised strongly to lose body weight in advance by increasing physical activity or through nutritional change. An important reason for losing weight is to increase the chance of surgical success by lowering infection rates and reducing problems of woundtissue healing.10,11 However, most patients report being unable to lose weight because of physical limitations and pain. Because the hip arthroplasty is supposed to diminish pain and increase mobility, patients assume weight loss will occur naturally after their surgery.12 Losing weight after hip arthroplasty is no less important. A high BMI after hip arthroplasty surgery has implications for implant stability, with a 6-fold higher risk for implant dislocation compared with a low BMI.13,14 In addition, Roder et al15 showed that each extra unit of BMI increases stem-loosening odds. Finally, it is known that a high BMI can affect polyethylene wear negatively, which in turn has a negative effect on implant
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