The Impact of Metabolic Syndrome on Reoperations and Complications After Primary Total Hip Arthroplasty

Cameron K. Ledford, Zachary M. Elstad, Kristin M. Fruth, Benjamin K. Wilke, Mark W. Pagnano, Daniel J. Berry, Matthew P. Abdel

Research output: Contribution to journalArticlepeer-review


Background: Metabolic syndrome (MetS) represents a constellation of interrelated conditions including insulin resistance, abdominal obesity, hypertension, and dyslipidemia. The goals of this study are to determine the impact of MetS on implant survivorship, complications, and clinical outcomes after primary total hip arthroplasty (THA). Methods: Utilizing our institutional total joint registry, 1,268 patients undergoing primary THA were identified with MetS based on the World Health Organization definition and matched 1:1 to those without MetS based on age, gender, and surgical year. MetS patients were further stratified according to the World Health Organization body mass index (BMI) classification to contextualize obesity. Kaplan-Meier analyses were utilized to compare survivorship free of any reoperation, revision, and complications. Clinical outcomes were assessed with Harris hip scores. Mean follow-up after THA was 5 years. Results: MetS patients had significantly worse 5-year survivorship free from any reoperation compared to those without MetS (93.5% vs 96.1%, respectively; hazard ratio [HR] 1.4, P = .04). When stratifying MetS and BMI classification, the BMI >40 kg/m2 had significantly decreased 5-year implant survivorship free from any reoperation (85.9% vs 96.1%, HR 3.4, P < .001), any revision (91.7% vs 97.3%, HR 2.7, P < .001), and reoperation for periprosthetic joint infection (95% vs 99%, HR 5.1, P < .001). Both groups experienced significant and similar improvement in final Harris hip scores (P < .001). Conclusion: Patients with MetS had a 1.4-fold increased risk of reoperation after primary THA compared to a matched cohort without the condition. MetS patients with a BMI >40 kg/m2 had the highest risk of reoperation, and had a significantly higher revision and periprosthetic joint infection rates, suggesting that morbid obesity remains a critical, independent risk factor beyond MetS. Level of Evidence: Level 3, Case-control study.

Original languageEnglish (US)
Pages (from-to)1092-1097
Number of pages6
JournalJournal of Arthroplasty
Issue number6
StatePublished - Jun 2022


  • abdominal obesity
  • dyslipidemia
  • hypertension
  • insulin resistance
  • revision total hip arthroplasty (THA)
  • syndrome X

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine


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