Ten-year audit finds low level of complications and significant improvements in quality of life post-surgery
Around one-in-three hip or knee replacement patients in Ireland have a body mass index (BMI) over 30 when they had their procedure, significantly increasing the risk of complications from surgery, a new report has found.
The Irish National Orthopaedic Register (INOR) National Report found that, between 2015 and 2024, more than 43,000 hip and knee joint replacement procedures recorded across 17 public and private hospitals.
Ireland, a BMI over 30 is considered obese, and a BMI exceeding 40 is classified as morbidly obese, which significantly increases risks of infection, poor wound healing, and surgical complications in hip replacements. Surgeons often recommend reducing BMI to improve surgical outcomes.
Of the 18,102 knee replacement surgeries recorded, 33 per cent were carried out among patients with a BMI over 30. Among the 22,249 hip replacements, 27 per cent were in this category.
The proportion of patients with a BMI of more than 40 was eight per cent among knee replacements surgeries and four per cent among hip replacement procedures.
However, despite obesity being an important issue in surgical outcomes, less than one per cent of primary joint replacements were found to have a surgical site infection within 30 days of surgery.
A similar proportion experienced complications such as dislocation or periprosthetic fracture shortly after surgery, while approximately one per cent of patients required revision surgery within one year. Thirty-day mortality following surgery was extremely low at 0.1 per cent.
The report, published by the National Office of Clinical Audit (NOCA), found that osteoarthritis was overwhelmingly the main indication for joint replacement surgery, with 94 per cent of hip replacement patients and 97 per cent of knee replacement patients having osteoarthritis recorded as the reason for their procedure.
“Joint replacement surgery is often performed when osteoarthritis has caused severe pain and significantly limits a person’s mobility and quality of life,” said Prof John Quinlan, INOR clinical lead and president of the Irish Institute for Trauma and Orthopaedic Surgery.
“The data from INOR show that while these are major procedures, they are very safe, with very low complication rates. Importantly, the patient-reported outcome measures collected by the register demonstrate significant improvements in pain, mobility and overall quality of life following surgery.
“Another key benefit of a national register like INOR is the ability to track the implants used in each procedure. This means that if a safety concern or implant recall ever arises, hospitals can quickly identify the patients affected and provide appropriate follow-up care.”
The average age of patients undergoing hip replacement was 70 years, and 72 years for knee replacement.
Inconsistent data coverage, particularly in the early years of the audit period, means that not all joint replacement surgeries in Ireland have been recorded. However, among those noted in the report, women made up the majority of patients, accounting for 57 per cent of knee replacements and 51 per cent of hip surgeries.
Patient-reported outcome measures show significant improvements in mobility, pain levels and overall quality of life, sustained for many years after surgery.
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