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. 2025 Apr 29;145(1):277.
doi: 10.1007/s00402-025-05889-7.

The impact of obesity on functional outcomes in navigation-assisted total hip arthroplasty

Roham Borazjani  1 , Danielle DeMoes  2 , Amir Human Hoveidaei  3 , Stefan Kreuzer  4
Affiliations

The impact of obesity on functional outcomes in navigation-assisted total hip arthroplasty

Roham Borazjani et al. Arch Orthop Trauma Surg. .

Abstract

Introduction: Functional outcomes after total hip arthroplasty (THA) are generally poorer in obese patients compared to non-obese individuals. However, the effect of obesity on functional improvement following navigation-assisted HA remains controversial. This study investigates whether BMI influences functional outcome improvements following navigation-assisted THA.

Materials and methods: We reviewed our institutional database from 2010 to 2024 for patients undergoing navigation-assisted unilateral primary THA. Patients were categorized as Healthy weight (18.5-25.0 Kg/m2), Overweight (25.0-29.9 Kg/m2), and Obese (30-39.9 Kg/m2), based on their preoperative BMI. Hip Disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS JR) was compared across BMI groups as the primary outcome. Multiple linear regression models were used to investigate the effect of BMI groups on Delta HOOS JR and postoperative HOOS JR while controlling for confounding variables.

Results: A total of 1,543 cases with a mean age of 62.80 years (range: 23-94) were included. Most patients were Overweight (40.5%), followed by Obese (32.9%) and Healthy weight (26.6%). Although obese patients had significantly lower preoperative and postoperative functional scores (p < 0.05), they demonstrated greater improvements in HOOS symptoms (44.68 ± 22.45 vs. 40.68 ± 22.29, p = 0.006) and activities of daily living (46.36 ± 20.85 vs. 42.10 ± 21.20, p = 0.002) compared to the Healthy weight group. Despite obesity being linked to lower postoperative HOOS JR, regression analysis showed age ≥ 60 years, men, and alcohol consumption-but not BMI status-negatively affected Delta HOOS JR.

Conclusions: The obese group exhibited better improvements in HOOS symptoms and ADL with comparable Delta HOOS JR, supporting navigation-assisted THA as a valuable option for obese patients. The results of this study may help surgeons provide evidence-based preoperative counseling to obese patients regarding the expected clinical outcomes of THA.

Keywords: Hip disability and osteoarthritis outcome score for joint replacement; Navigation system; Obesity; Patient-reported outcomes; Total hip arthroplasty.

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Conflict of interest statement

Declarations. Competing interests: Roham Borazjani declared that he is an editorial board member at PLoS ONE and World Journal of Orthopedics which is not related to this work Stefan Kreuzer declared the following potential conflicts of interest: Corin Group USA: consulting, holding equity, receiving speaking fees, and travel reimbursements./ Naviswiss Inc.: Involved in consulting, receives funding grants, speaking fees, and travel reimbursements./ Medtrade Products Ltd: Provides consulting services./ CeramTec GmbH: Engaged in consulting and receives travel reimbursements./ ISTA, PAS, and Caira Surgical: Serves as a board member./ Restore 3D: Holds a board position and is compensated through consulting, speaking fees, and travel reimbursements. Which are not related to this work.Amir Human Hoveidaei is an editorial board member at International Orthopaedics, Bone Reports, BMC Research Notes, PlosOne, Frontiers in Rehabilitation Sciences. Not related to this workDanielle DeMoes has nothing to declare.

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