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. 2020 Aug 10;6(3):571-577.
doi: 10.1016/j.artd.2020.06.010. eCollection 2020 Sep.

Metabolic Syndrome Is Associated With Higher Risk of Wound Complications After Total Hip Arthroplasty

Karen Y Cheng  1 , Scott T Ball  2 , Francis B Gonzales  2 , Simon Schenk  2 , Jan M Hughes-Austin  2
Affiliations

Metabolic Syndrome Is Associated With Higher Risk of Wound Complications After Total Hip Arthroplasty

Karen Y Cheng et al. Arthroplast Today. .

Abstract

Background: Obesity is prevalent among patients undergoing total hip arthroplasty and has been associated with the risk of wound complications, particularly when an anterior approach is used. However, most studies have focused on obesity defined by the body mass index (BMI), without considering the metabolic effects of adiposity. Thus, in this study, we investigated the independent effects of the BMI and metabolic syndrome on wound complications after total hip arthroplasty.

Methods: Among 804 consecutive patients undergoing total hip arthroplasty between October 2013 and July 2016, we evaluated the associations between obesity (BMI ≥30 mg/kg2), metabolic syndrome (defined by the National Cholesterol Education Program Adult Treatment Panel III guidelines), and wound complication (defined as documented wound dehiscence, drainage, erythema, hematoma, infection, or seroma) over a 1-year follow-up period. We used Cox proportional hazards models adjusting for demographics, smoking status, and hospital length of stay.

Results: Patients' mean age at time of surgery was 62.0 ± 11.9 years. Forty-seven percent were male, 27.9% were obese, and 11.6% met the definition for metabolic syndrome. Metabolic syndrome was associated with a 4-fold higher risk of wound complication (95% confidence interval: 1.4-11.1) after adjusting for all covariates including the BMI. In unadjusted analysis, obesity was associated with a higher risk of wound complication (hazard ratio: 2.8, 95% confidence interval: 1.3-6.2). However, obesity was not associated with the risk of wound complication after adjusting for the metabolic syndrome (P = .16).

Conclusions: Metabolic syndrome, but not obesity, defined by a BMI ≥30, was associated with wound complications, suggesting that metabolic effects of adiposity may represent a distinct risk factor in the development of wound complications from a higher BMI alone.

Keywords: Metabolic syndrome; Obesity; Total hip arthroplasty; Wound complication.

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Figures

Figure 1
Figure 1
Obesity phenotypes in the study population. MHNW, metabolically healthy, normal weight; MHO, metabolically healthy, obese; MONW, metabolically obese (metabolic syndrome), normal weight; MOO, metabolically obese (metabolic syndrome), obese.
See this image and copyright information in PMC

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