Extremes of body mass index have significant impact on complications, readmissions, and utilization of post-acute services after primary total hip arthroplasty.

Document Type


Publication Date


Publication Title

Bone Joint J


Adolescent; Adult; Aged; Aged, 80 and over; Arthroplasty, Replacement, Hip; Body Mass Index; Female; Humans; Length of Stay; Male; Middle Aged; Obesity; Operative Time; Patient Readmission; Postoperative Complications; Retrospective Studies; United States; Young Adult


AIMS: High body mass index (BMI) is associated with increased rates of complications in primary total hip arthroplasty (THA), but less is known about its impact on cost. The effects of low BMI on outcomes and cost are less understood. This study evaluated the relationship between BMI, inpatient costs, complications, readmissions, and utilization of post-acute services.

METHODS: A retrospective database analysis of 40,913 primary THAs performed between January 2013 and December 2017 in 29 hospitals was conducted. Operating time, length of stay (LOS), complication rate, 30-day readmission rate, inpatient cost, and utilization of post-acute services were measured and compared in relation to patient BMI.

RESULTS: Mean operating time increased with BMI and for BMI > 50 kg/m

CONCLUSION: LOS, complications, and 30-day readmissions all increase at the extremes of BMI and appear to be greater than those of patients with normal BMI. The lowest BMI patients had the lowest payment for inpatient stay yet were at considerable risk for complications and readmission. Patients with extreme BMI should be counselled about their increased risk of complications for THA and nutritional status/obesity optimized preoperatively if possible. Cite this article: Bone Joint J 2020;102-B(7 Supple B):62-70.

Clinical Institute

Orthopedics & Sports Medicine