Total hip arthroplasty in obesity: separating ‘fat’ from fiction

Obesity is a modern-day epidemic with increasing prevalence that is directly impacting the global burden of primary total hip arthroplasty. The risk of requiring total hip arthroplasty for osteoarthritis increases incrementally with increasing obesity class. Surgical intervention in obese patients presents a set of unique challenges that should be recognized by the treating medical team. Although predominantly satisfactory outcomes have been reported, perioperative anaesthetic and surgical concerns require thorough patient assessment. There is an increased potential risk of thrombogenic and septic complications, but the body mass index cutoff level beyond which total hip arthroplasty should not be offered in the obese patient remains controversial. Preoperative medical optimization of the patient and appropriate intraoperative interventions are essential to mitigate the risk of complications.