In practice, obesity leads to poor functional outcomes after total hip arthroplasty (THA). However, in clinical research, the influence of body mass index (BMI) on the gait recovery and kinematics for THA is not well documented. The purpose of this study was to assess the influence of BMI on gait parameters pre-operatively and six months after THA for hip osteoarthritis (OA) patients.
We included 76 THA for hip OA: non-obese group (G1): 49 (BMI < 30 kg/2) and obese group (G2): 37 (BMI ≥ 30 kg/m2) with a control group of 61 healthy people. Clinical evaluation (HOOS) and a 3D gait analysis (gait speed and flexion range of the hip (ROM)) were performed before and six months after THA: The gains between the two visits were calculated and we looked for correlations between outcomes and BMI.
Preoperative gait speed and hip ROM were significantly lower in obese patients (speed G1: 0.81 ± 0.22 m/s vs. G2: 0.64 ± 0.23 m/s, p = 0.004 and hip ROM G1: 26.1° ± 7.3 vs. G2: 21.4° ± 6.6, p = 0.005), and obese patients were more symptomatic. At six months, gait speed and hip ROM were significantly lower for all patients compared with the control group. No correlation between gait velocity, hip ROM, and BMI was found. Biomechanical and clinical gains were comparable in the two groups.
All patients, including obese patients, have significant functional improvement after THA, objectively assessed by gait speed. Even if patients did not fully recover to the level of a healthy control person after THA, functional gain is comparable irrespective of BMI.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Grotle M, Hagen KB, Natvig B, Dahl FA, Kvien TK (2008) Obesity and osteoarthritis in knee, hip and/or hand: an epidemiological study in the general population with 10 years follow-up. BMC Musculoskelet Disord 9:132. https://doi.org/10.1186/1471-2474-9-132
Reyes C, Leyland KM, Peat G, Cooper C, Arden NK, Prieto-Alhambra D (2016) Association between overweight and obesity and risk of clinically diagnosed knee, hip, and hand osteoarthritis: a population-based cohort study. Arthritis Rheumatol 68:1869–1875. https://doi.org/10.1002/art.39707
Kiadaliri AA, Lohmander LS, Moradi-Lakeh M, Petersson IF, Englund M (2017) High and rising burden of hip and knee osteoarthritis in the Nordic region, 1990-2015. Acta Orthop 1–7. https://doi.org/10.1080/17453674.2017.1404791
Maisongrosse P, Lepage B, Cavaignac E, Pailhe R, Reina N, Chiron P, Laffosse J-M (2014) Obesity is no longer a risk factor for dislocation after total hip arthroplasty with a double-mobility cup. Int Orthop. https://doi.org/10.1007/s00264-014-2612-7
Haverkamp D, Klinkenbijl MN, Somford MP, Albers GHR, van der Vis HM (2011) Obesity in total hip arthroplasty—does it really matter? Acta Orthop 82:417–422. https://doi.org/10.3109/17453674.2011.588859
Memtsoudis SG, Besculides MC, Gaber L, Liu S, González Della Valle A (2009) Risk factors for pulmonary embolism after hip and knee arthroplasty: a population-based study. Int Orthop 33:1739–1745. https://doi.org/10.1007/s00264-008-0659-z
Schwartz BE, Piponov HI, Helder CW, Mayers WF, Gonzalez MH (2016) Revision total hip arthroplasty in the United States: national trends and in-hospital outcomes. Int Orthop 40:1793–1802. https://doi.org/10.1007/s00264-016-3121-7
Ma Z, Guo F, Qi J, Xiang W, Zhang J (2016) Meta-analysis shows that obesity may be a significant risk factor for prosthetic joint infections. Int Orthop 40:659–667. https://doi.org/10.1007/s00264-015-2914-4
Girardi FM, Liu J, Guo Z, Valle AGD, MacLean C, Memtsoudis SG (2018) The impact of obesity on resource utilization among patients undergoing total joint arthroplasty. Int Orthop. https://doi.org/10.1007/s00264-018-4059-8
Behery OA, Foucher KC (2014) Are Harris hip scores and gait mechanics related before and after THA? Clin Orthop 472:3452–3461. https://doi.org/10.1007/s11999-014-3886-1
Hayashi S, Nishiyama T, Fujishiro T, Hashimoto S, Kanzaki N, Nishida K, Kurosaka M (2012) Obese patients may have more soft tissue impingement following primary total hip arthroplasty. Int Orthop 36:2419–2423. https://doi.org/10.1007/s00264-012-1701-8
Runhaar J, Koes BW, Clockaerts S, Bierma-Zeinstra SMA (2011) A systematic review on changed biomechanics of lower extremities in obese individuals: a possible role in development of osteoarthritis. Obes Rev 12:1071–1082. https://doi.org/10.1111/j.1467-789X.2011.00916.x
Ibrahim T, Hobson S, Beiri A, Esler CN (2005) No influence of body mass index on early outcome following total hip arthroplasty. Int Orthop 29:359–361. https://doi.org/10.1007/s00264-005-0012-8
Kim Y-H, Park J-W, Kim J-S (2014) Outcome of an ultrashort metaphyseal-fitting anatomic cementless stem in highly active obese and non-obese patients. Int Orthop. https://doi.org/10.1007/s00264-014-2520-x
Judge A, Batra RN, Thomas GE, Beard D, Javaid MK, Murray DW, Dieppe PA, Dreinhoefer KE, Peter-Guenther K, Field R, Cooper C, Arden NK (2014) Body mass index is not a clinically meaningful predictor of patient reported outcomes of primary hip replacement surgery: prospective cohort study. Osteoarth Cartil 22:431–439. https://doi.org/10.1016/j.joca.2013.12.018
Yeung E, Jackson M, Sexton S, Walter W, Zicat B, Walter W (2011) The effect of obesity on the outcome of hip and knee arthroplasty. Int Orthop 35:929–934. https://doi.org/10.1007/s00264-010-1051-3
Bierma-Zeinstra S, Bohnen A, Ginai A, Prins A, Verhaar J (1999) Validity of American College of Rheumatology criteria for diagnosing hip osteoarthritis in primary care research. J Rheumatol 26:1129–1133
Barre A, Armand S (2014) Biomechanical ToolKit: open-source framework to visualize and process biomechanical data. Comput Methods Prog Biomed 114:80–87. https://doi.org/10.1016/j.cmpb.2014.01.012
Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16:494–502
Ornetti P, Parratte S, Gossec L, Tavernier C, Argenson J-N, Roos EM, Guillemin F, Maillefert JF (2010) Cross-cultural adaptation and validation of the French version of the Hip disability and Osteoarthritis Outcome Score (HOOS) in hip osteoarthritis patients. Osteoarthr Cartil 18:522–529. https://doi.org/10.1016/j.joca.2009.12.007
Tubach F (2005) Evaluation of clinically relevant states in patient reported outcomes in knee and hip osteoarthritis: the patient acceptable symptom state. Ann Rheum Dis 64:34–37. https://doi.org/10.1136/ard.2004.023028
Cohen J (1988) Statistical power analysis for the behavioral sciences. L. Erlbaum Associates
Martz P, Bourredjem A, Laroche D, Arcens M, Labattut L, Binquet C, Maillefert J-F, Baulot E, Ornetti P (2017) Röttinger approach with dual-mobility cup to improve functional recovery in hip osteoarthritis patients: biomechanical and clinical follow-up. Int Orthop 41:461–467. https://doi.org/10.1007/s00264-016-3245-9
Bennett D, Ryan P, O’Brien S, Beverland DE (2017) Gait kinetics of total hip replacement patients-a large scale, long-term follow-up study. Gait Posture 53:173–178. https://doi.org/10.1016/j.gaitpost.2017.01.014
Ewen AM, Stewart S, St Clair Gibson A, Kashyap SN, Caplan N (2012) Post-operative gait analysis in total hip replacement patients—a review of current literature and meta-analysis. Gait Posture 36:1–6. https://doi.org/10.1016/j.gaitpost.2011.12.024
Weber M, Weber T, Woerner M, Craiovan B, Worlicek M, Winkler S, Grifka J, Renkawitz T (2015) The impact of standard combined anteversion definitions on gait and clinical outcome within one year after total hip arthroplasty. Int Orthop 39:2323–2333. https://doi.org/10.1007/s00264-015-2777-8
Foucher KC, Freels S (2015) Preoperative factors associated with postoperative gait kinematics and kinetics after total hip arthroplasty. Osteoarthr Cartil 23:1685–1694. https://doi.org/10.1016/j.joca.2015.05.005
Kolk S, Minten MJM, van Bon GEA, Rijnen WH, Geurts ACH, Verdonschot N, Weerdesteyn V (2014) Gait and gait-related activities of daily living after total hip arthroplasty: a systematic review. Clin Biomech (Bristol, Avon) 29:705–718. https://doi.org/10.1016/j.clinbiomech.2014.05.008
Bennett D, Humphreys L, O’Brien S, Kelly C, Orr JF, Beverland DE (2008) Gait kinematics of age-stratified hip replacement patients—a large scale, long-term follow-up study. Gait Posture 28:194–200. https://doi.org/10.1016/j.gaitpost.2007.11.010
Ko S, Stenholm S, Ferrucci L (2010) Characteristic gait patterns in older adults with obesity - results from the Baltimore longitudinal study of aging. J Biomech 43:1104–1110. https://doi.org/10.1016/j.jbiomech.2009.12.004
Michalka PKR, Khan RJK, Scaddan MC, Haebich S, Chirodian N, Wimhurst JA (2012) The influence of obesity on early outcomes in primary hip arthroplasty. J Arthroplast 27:391–396. https://doi.org/10.1016/j.arth.2011.05.012
Lübbeke A, Duc S, Garavaglia G, Finckh A, Hoffmeyer P (2009) BMI and severity of clinical and radiographic signs of hip osteoarthritis. Obesity. https://doi.org/10.1038/oby.2008.663
Bonnefoy-Mazure A, Martz P, Armand S, Sagawa Junior Y, Suva D, Turcot K, Miozzari HH, Lübbeke A Influence of body mass index on sagittal knee range of motion and gait speed recovery one year after total knee arthroplasty. J Arthroplast. https://doi.org/10.1016/j.arth.2017.03.008
Camomilla V, Bonci T, Cappozzo A (2017) Soft tissue displacement over pelvic anatomical landmarks during 3-D hip movements. J Biomech 62:14–20. https://doi.org/10.1016/j.jbiomech.2017.01.013
Horsak B, Schwab C, Clemens C, Baca A, Greber-Platzer S, Kreissl A, Kranzl A (2018) Is the reliability of 3D kinematics of young obese participants dependent on the hip joint center localization method used? Gait Posture 59:65–70. https://doi.org/10.1016/j.gaitpost.2017.09.029
Conflict of interest
Authors declare that they have no conflict of interest.
IRB/ethical committee approval
The study protocol was approved by the local ethics committee (CPP Est 1. Dijon. France). It was conducted in accordance with the principles of good clinical practice and the declaration of Helsinki, and it is referenced in the clinical trials website: NCT02042586.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Level of evidence: II, prospective comparative study.
About this article
Cite this article
Martz, P., Bourredjem, A., Maillefert, J.F. et al. Influence of body mass index on sagittal hip range of motion and gait speed recovery six months after total hip arthroplasty. International Orthopaedics (SICOT) 43, 2447–2455 (2019). https://doi.org/10.1007/s00264-018-4250-y
- Gait analysis
- Total hip arthroplasty