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Background and objective:  There is a general clinical concern on the negative impact of obesity on surgical complications and functional outcomes. We hypothesized that the patients with morbid obesity are exceptionally prone to a significantly increased risk for surgical and short-term complications after primary total hip arthroplasty (THA). We aimed to identify the range of Body Mass Index (BMI) values of patients with a significant risk for lower functional improvement after THA.  Materials and methods:  In Stage 1 of the study, we conducted a retrospective comparative analysis of the rate of complications and functional outcomes in patients treated by primary THA, with normal weight (BMI 19–25,  N  = 1205) vs. Class 1 (BMI 26–34,  N  = 450), Class 2 (BMI 35–39,  N  = 183), and Class 3 (BMI ≥ 40,  N  = 47) obese patients. After the statistical similarity rates of complications and 6- and 12-month functional outcomes (by Harris Hip and SF-36 scores) were revealed in Class 1 patients and patients with normal BMI, we conducted the Stage 2 prospective study, by the same comparison protocol, on the cohorts of Class 2 ( N  = 29) and Class 3 ( N  = 16) patients compared to the Class 1 patients ( N  = 37) as controls.  Results:  Stage 1: There was no difference in surgical complications and function on 6- and 12-month postoperative follow-up (physical and mental) between Class 1 and patients with normal BMI ( p  > 0.05). Surgical complications were significantly higher in Class 2 ( p  < 0.05) and Class 3 ( p  < 0.001) patients. Functional activity on the 12-month follow-up increased significantly in all study groups, but in the Class 3 patients, the functional parameters were significantly lower (0.001). The mental health status on the follow-up was similar in all study groups. Stage 2 study revealed similar to the retrospective study comparison of parameters, except for the significantly lower mental health scores in Class 2 and Class 3 patients ( p  < 0.05) and functional scores in Class 3 patients ( p  < 0.05).  Conclusion:  Although the functional ability increased in all patients, it was significantly lower in Class 3 patients (with morbid obesity). Therefore, the patients with Class 1 and Class 2 obesity should be conceptionally distinguished from Class 3 patients in the decision-making process for a primary THA because of the less favorable functional and mental health improvement in those with morbid obesity (Class 3).

Clinical Outcome of Primary Total Hip Arthroplasty in Patients with Morbid Obesity—Retrospective and Prospective Follow-Up Studies