Higher-Weight People Have Best Hip Surgery Outcomes in New Study

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I’ve previously written a series about fat people and joint health, including joint pain, osteoarthritis, and resources to fight BMI-based joint surgery denials. I’ve added a new resource to the list thanks to Dr. Greg Dodell who let me know about this new study.

Before I get into this particular study, I want to offer a reminder that even if higher-weight people didn’t have the same outcomes as thin people:

1.       That wouldn’t mean that the patient’s weight is the problem. There are any number of confounding variables (including the impact of weight cycling on the patient, practitioner weight bias impacting the procedure, structural weight stigma impacting the procedure - including tools, best practices, and other medical equipment being developed for thin bodies and often to the exclusion of fat bodies - and the impact of patients trying to lose weight prior to surgery and going into the surgery undernourished.)

2.       That wouldn’t make weight loss the correct next step. First of all, because it’s highly unlikely to work and second of all because it’s possible that the weight loss attempt, even if it is successful in the short term, could negatively impact surgical outcomes as this study shows.

3.       That shouldn’t automatically be a reason for denying the surgery. The idea that fat people only deserve healthcare if they have the same outcomes as thinner people is based in weight-stigma. It also means that the ways that the healthcare system fails to support and accommodate fat people then gets taken out on fat people, then subsequently used to justify more exclusion of fat people from care. Fat people getting a surgery to reduce pain or improve quality of life is a worthy goal, even if there might be more complications or different outcomes. If there is actually a higher risk for higher-weight people (and that would require good, unbiased research to detect) then, first and foremost, we should get better at performing surgeries and after care on fat patients and, in the meantime, the risk should be communicated accurately to the patient and then the patient should be allowed to make the choice. I want to note that that would require systemic change to the way that surgeons’ performance/statistics are judged so that they aren’t encouraged to cherry pick the easiest cases and deny care to those who might be (or whom they perceive might be) at greater risk for complications.

With all of that said, let’s look at this study - Differential Impact of Body Mass Index in Hip Arthroscopy: Ob*sity Does Not Impact Outcomes., by Suri et al published in The Ochsner Journal.

This study reviewed the medical records of 459 patients who had undergone hip arthroscopy at a single facility from 2008 to 2016. They divided the patients into BMI-based weight categories of “underweight,” “normal weight,” “overweight.” and “ob*se.” (Note that the entire idea of categorizing people by BMI is unscientific and harmful.) Then they looked at their rates of improvement at 1 and 2 years after surgery.

They utilized three metrics:

The Harris Hip Score (HHS) which considers pain, function, absence of deformity, and and range of motion, the physical component score from the 12-Item Short Form Survey (PCS-12) and the mental component score from the 12-Item Short Form Survey (MCS-12).

They found that

At 1 and 2 years postoperatively, all cohorts experienced statistically significant improvements in the HHS and PCS-12. At 3 years postoperatively, statistically significant improvements were seen in the HHS for all cohorts; in the PCS-12 for the normal weight, overweight, and ob*se cohorts; and in the MCS-12 for the normal weight cohort. Intercohort differences were not statistically significant at 1, 2, or 3 years postoperatively.

They concluded:In our population, BMI did not have statistically significant effects on patient outcome scores following hip arthroscopy. All patient cohorts showed postoperative improvements, and differences between BMI cohorts were not statistically significant at any postoperative time point.

Statistical significance is a measure of how likely it is that the effect was due to the intervention or rather than by chance, there is a more detailed explanation here.

Interestingly, in follow up three years after surgery (which was the longest follow-up) the “ob*se” group had the highest overall score on all three instruments, followed by the “overweight” group, then the “normal weight” group, with the the “underweight” group showing the lowest overall improvement:

There are limitations to this study including the small sample size, the single facility, the relatively short follow-up, and the lack of information about re-surgery rates.

Still, this finding is important because, as the study authors point out, “the goals of hip arthroscopy are to alleviate symptoms, improve hip function, and delay the progression of hip osteoarthritis.”

So if this surgery is denied based on BMI, then it would be expected that the patient’s symptoms would continue to worsen, possibly leading to the need for a total hip replacement which is even more likely to be denied based on BMI. This leaves fat patients with completely unnecessary pain, suffering, and mobility issues.

Again, even if higher-weight people had worse outcomes, reducing their symptoms, improving their hip function, and delaying the progression of hip osteoarthritis would still be worthy goals, and fat people would still deserve surgery, just like “underweight” people deserve surgeries.

And again, this study has significant limitations, and, regardless of the results, people of all sizes deserve healthcare. Still, it is often suggested that all the research supports a narrative of higher-weight people having worse surgical outcomes and it’s important that misinformation and commonly held misbeliefs in healthcare be challenged.

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\More research and resources:https://haeshealthsheets.com/resources/

*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings Fearing the Black Body – the Racial Origins of Fat Phobia and Da’Shaun Harrison Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.Note I don’t link to everything I discuss in this post because I don’t want to give traffic and clicks to dangerous media.