膝髋骨性关节炎关节置换术后下肢深静脉血栓发生的常见危险因素分析

[目的]分析膝、髋关节骨性关节炎(osteoarthritis,OA)人工关节置换术后下肢深静脉血栓(deep venous thrombosis,DVT)形成的常见危险因素。[方法]2010年8月²012年2月行全膝、髋关节置换术的患者456例,所有患者均在术后32012年2月行全膝、髋关节置换术的患者456例,所有患者均在术后3⁵ d行下肢深静脉造影。根据造影结果分为DVT组(男22例,女121例;平均年龄66.97岁)和非DVT组(男68例,女245例;平均年龄65.93岁),分析两组患者中年龄、性别、糖尿病、高血压、心血管疾病史、血栓史、恶性肿瘤史、体重指数(Body mass index,BMI)、吸烟史及手术类型与DVT发生风险的潜在相关性。[结果]OA患者中,BMI≥25 kg/m2(OR=1.716;95%CI=1.100-2.675;P=0.017)和心血管疾病史(OR=3.403;95%CI=1.129-10.260;P=0.030)能显著增加关节置换术后DVT的发生风险。[结论]高BMI和心血管疾病史是膝、髋OA患者行关节置换术后DVT发生的危险因素。     

术前D－二聚体升高对全膝关节置换术后深静脉血栓形成的影响

[目的]探讨低血栓风险人群术前D-二聚体升高对膝关节置换术后下肢深静脉血栓(DVT)形成的影响。[方法]采用病例对照研究方式,系统回顾本院2016年9月～2018年1月行单侧全膝关节置换术的198例患者资料,其中术后发生DVT的患者共77例列入血栓组,未发生DVT的患者121例列入对照组,比较两组年龄、BMI、血压、和术前D-二聚体升高、血脂异常、糖尿病史比率,筛选与术后血栓形成相关的危险因素,并进行多因素逻辑回归分析。[结果]血栓组的年龄(65.61±7.92)岁均大于对照组(62.53±7.75)岁,差异有统计学意义(P0.05);血栓组BMI (28.61±3.01) kg/m2大于对照组(27.24±3.04) kg/m2,差异有统计学意义(P0.05)。血栓组术前D-二聚体升高比率显著大于对照组(OR=5.337, 95%CI 2.388～11.923, P0.05)。逻辑回归分析表明术前D-二聚体升高(OR=5.162, 95%CI 2.321～11.467)和BMI (OR=1.639, 95%CI 1.051～2.582)是术后血栓形成的独立的危险因素。[结论]术前D-二聚体升高患者术后发生血栓的风险是D-二聚体正常患者的5.162倍;患者BMI (体重正常BMI24,超重24≤BMI28,肥胖BMI≥28)每跨越一个等级,术后血栓风险增加1.639倍。     

人工全髋关节置换术后下肢深静脉血栓形成的多因素分析

目的:分析影响人工全髋关节置换术(THA)后下肢深静脉血栓形成(DVT)的危险因素。方法:对98例(112个关节)人工全髋置换术术后DVT发生情况进行分析。其中男55例,女43例;平均年龄59.12岁(41～81岁)。术前及术后7～10d均用彩色多普勒检查双下肢深静脉血流通畅情况及DVT的发生。对17项临床因素与人工关节置换术后DVT形成的相关性进行了分析。结果:术后发生DVT41例,DVT发生率为41.84%(41/98),其中无症状DVT患者占58.54%(24/41)。经Logistic多因素回归分析,与DVT相关的因素有5个,其中年龄、肥胖及肢体延长大于2cm使术后发生DVT的风险分别增加到1.952、3.349及7.376倍(P<0.05);硬膜外麻醉和踝泵练习使术后发生DVT的可能性减少到原来的0.132和0.265(P<0.01)。结论:年龄、肥胖及肢体延长大于2cm是人工关节置换术后发生DVT的危险因素,而硬膜外麻醉和踝泵练习是减少术后发生DVT的保护因素。关节置换术后无症状DVT的大量存在,提示术后最好常规行双下肢彩色多普勒检查,一旦有DVT发生,及时治疗,防止发生致命性肺栓塞。     

腹腔镜手术中肥胖患者呼吸系统的临床观察

目前腹腔镜手术多需CO2 气腹和体位改变来满足手术要求 ,CO2 气腹和体位改变等因素带来的生理影响给麻醉师提出了更多的要求 ,我们选取了 2 0例肥胖患者和同等例数的普通患者 ,在全麻下行腹腔镜胆囊切除术 (LC) ,观察对比气腹前后的呼吸变化 ,以研究CO2 气腹对肥胖患者呼吸的影响。1　资料与方法1 1　临床资料　择期行LC4 0例 ,男 2 8例 ,女 12例 ,其中肥胖患者 2 0例 ,体重 80 ～95kg(BMI>2 0kg/m2 )。普通患者 2 0例 ,体重 4 0 ～75kg(BMI <2 0kg/m2 )。 30 ～5 5岁 ,平均 4 2± 13岁 ,ASAⅠ Ⅱ级。术前 5例ECG有异常改变 (ST T…     

老年患者低体重指数增加术后谵妄风险:前瞻性队列研究

目的分析老年患者术后谵妄的危险因素,探究体重指数(BMI)与老年患者术后谵妄的关系。方法本研究为前瞻、观察性队列研究。2011年5月至2013年11月全身麻醉下接受非心脏手术后入ICU的老年患者350例,年龄≥65岁。使用CAM-ICU法每天2次评估术后7d内谵妄发生情况。使用Logistic多因素回归分析评估术后谵妄的危险因素。结果共79例(22.6%)患者发生术后谵妄。参照WHO亚洲人BMI参考标准,将患者分为偏瘦(BMI18.5kg/m2)、正常(BMI18.5~22.9kg/m2)、偏胖(BMI 23.0~24.9kg/m2)、肥胖(BMI 25.0~29.9kg/m2)、重度肥胖(BMI≥30.0kg/m2)5个等级,将BMI分级代入Logistic多因素回归模型,结果显示与正常BMI者比较,偏瘦者术后谵妄风险增加(OR 2.551,95%CI 1.101~5.909,P=0.029),而偏胖、肥胖与重度肥胖者不增加术后谵妄风险。对BMI进行ROC曲线分析,得出谵妄风险增加的拐点BMI为20.0kg/m2,根据此拐点将BMI转换为二分类变量并代入Logistic多因素回归模型,结果显示BMI20.0kg/m2者术后谵妄发生风险明显增加(OR 2.679,95%CI 1.438~4.990,P=0.001)。结论对于非心脏手术后进入ICU的老年患者,低体重指数(BMI20.0kg/m2)是增加术后谵妄风险的独立危险因素之一。     

肥胖对肺切除术后并发症发生的影响

目的探讨肥胖对肺切除术后并发症发生和手术死亡率的影响。方法回顾性分析2003年9月至2007年12月上海市肺科医院3 494例肺部疾病行肺切除术患者的临床资料,依据体重指数(body mass index,BMI)不同将3 494例患者分为两组,非肥胖组(BMI<28 kg/m2):3 340例,男2 502例,女838例;年龄(61.9±10.7)岁;肥胖组(BMI≥28 kg/m2):154例,男87例,女67例;年龄(59.7±9.6)岁。通过单因素和logistic多因素回归分析肥胖(BMI≥28 kg/m2)对肺切除术后并发症发生的影响。结果围术期共死亡26例,其中非肥胖组死亡23例,肥胖组死亡3例,两组患者的病死率比较差异无统计学意义[0.7%(23/3 340)vs.1.9%(3/154),P=0.118]。两组患者任一并发症和呼吸系统并发症发生率比较差异均无统计学意义(P>0.05)。除呼吸系统外,肥胖组患者其它系统并发症发生率显著高于非肥胖组(P<0.05),脑血管意外、心肌梗死和急性肾功能衰竭发生率高于非肥胖组(P<0.05)。Logistic多因素回归分析结果显示:肥胖(BMI≥28 kg/m2)不是肺切除术后并发症发生的独立危险因素[回归系数为0.648、OR值为1.911,95%CI(0.711,5.138),P值为0.199]。结论肥胖不引起肺切除术后手术死亡率和并发症发生率的显著增高。     

影响人工关节置换术后下肢深静脉血栓形成的临床风险因素分析

目的 分析影响人工关节置换术后下肢深静脉血栓形成（DVT）的临床风险因素。方法对2004年4月至8月95例128个人工髋、膝关节置换术术后DVT发生情况进行分析。其中男性27例,女性68例,平均年龄60岁（23～78岁）。人工髋关节置换术（THA）43例48髋,人工膝关节置换术（TKA）52例80膝。术前及术后7～10d均用彩色多普勒检查双下肢深静脉血流通畅情况及DVT的发生。对19项临床因素与人工关节置换术后DVT形成的相关性进行了分析。结果术后发生DVT的患者有45人,DVT发生率为47．4％（45／95）,其中无症状DVT患者占57．8％（26／45）。经logistic多因素回归分析,与DVT相关的因素有4个,其中女性、肥胖及骨水泥的使用使术后发生DVT的风险分别增加到10．008、3．094、8．887倍（P〈0．05）;类风湿关节炎的诊断使术后发生DVT的可能性减少到0．194倍（P〈0．05）。结论女性、肥胖及骨水泥的使用是人工关节术后发生DVT的危险因素,而类风湿关节炎（RA）则是减少术后发生DVT的保护因素;关节置换术后无症状DVT的大量存在,提示我们术后最好常规行双下肢彩色多普勒或造影检查,一旦有DVT发生,及时治疗,防止发生致命性肺栓塞。     

关节镜下经取腱切口与经前内侧技术定位股骨隧道重建前十字韧带的对比研究

目的比较采用关节镜下经取腱切口(tendon incision, TI)与经前内侧(anteromedial, AM)技术定位股骨隧道重建前十字韧带(anterior cruciate ligament, ACL)的短期临床疗效。方法回顾性分析2015年12月至2017年3月, 中国科学技术大学附属第一医院骨科采用关节镜下ACL重建术治疗ACL损伤患者176例, 根据定位股骨隧道的方法分为TI组(经TI技术定位股骨隧道重建ACL)和AM组(经AM技术定位股骨隧道重建ACL)。TI组87例, 男63例、女24例, 年龄(32.8±9.4)岁(范围19～51岁), 体质指数(body mass index, BMI)为(24.8±6.3)kg/m2(范围18.1～31.7 kg/m2), 其中肥胖(BMI>28 kg/m2)患者9例;AM组89例, 男59例、女30例, 年龄(36.7±13.0)岁(范围17～56岁), BMI为(25.7±5.8)kg/m2(范围18.9～31.6 kg/m2), 其中肥胖患者11例。评估两组患者术中钻头与股骨内髁软骨面接触、内侧半月板前角损伤情况...     

肥胖与四肢骨折愈合的相关性探讨

目的 探讨肥胖与四肢骨折愈合的相关性.方法 回顾分析自1994年8月～2006年8月收治的闭合性四肢长管状骨骨折患者1 218例,男性842例,女性376例;年龄6～75岁.按体重指数(BMI)情况分为2组,BMI＜25 kg/m2 824例,58例发生骨不连,76例发生骨延迟愈合;BMI≥25 kg/m2 394例,46例发生骨不连,57例发生骨延迟愈合.结果 BMI≥25 kg/m2者骨不连和骨延迟愈合发生率均明显高于BMI＜25 kg/m2(P＜0.01).结论 肥胖是引起骨折延迟愈合或不愈合的一个重要因素.     

髋臼骨折术后下肢深静脉血栓形成的多因素分析

目的 分析影响髋臼骨折术后下肢深静脉血栓形成(DVT)的危险因素.方法 对102髋臼骨折术后DVT发生情况进行分析.术前及术后7～10d均用彩色多普勒检查双下肢深静脉血流通畅情况及DVT的发生,并对11项临床因素与人工关节置换术后DVT形成的相关性进行分析.结果 髋臼骨折术后发生DVT有18例,DVT发生率为17.65%(18/102).经Logistic多因素回归分析,与DVT相关的因素有6个,其中年龄、肥胖、静脉曲张及手术方式使术后发生DVT的风险分别增加到4.075、7.803、46.176和4.251倍(P＜0.05);硬膜外麻醉和踝泵练习使术后发生DVT的风险减少到0.121和0.114倍(P＜0.01).结论 年龄和肥胖是人工关节术后发生DVT的危险因素,而硬膜外麻醉和踝泵练习则是术后发生DVT的保护因素.髋臼骨折术后无症状DVT的大量存在,提示术后最好常规行双下肢彩色多普勒检查,一旦有DVT发生,及时治疗,防止发生致命性肺栓塞.     

Morbid obesity in total hip arthroplasty: What does it mean?

Obesity affects 34% of the U.S. population, and the number of obese patients undergoing elective total hip arthroplasty (THA) is increasing each year. The objective of this study is to summarize the current scientific findings regarding the outcomes of THA in the morbidly obese (BMI > 40 kg/m²) patients. Specifically, our goal is to identify the incidence of complications and the influence on clinical and functional outcome measures in morbidly obese patients undergoing elective primary THA. A systematic review was performed identifying all of the studies from the PubMed, Medline, EBSCO and Cochrane Library databases that reported outcomes of primary THA in morbidly obese [body mass index (BMI) ≥ 40 kg/m²] patients. We identified 13 articles that met inclusion criteria for systematic review. These studies included 15,906 primary THAs in morbidly obese patients. Morbidly obese patients underwent THA at a significantly younger age compared to the non-morbidly obese cohort (63 years versus 70 years) comparator group. Eleven of the 13 studies reported complication rates in morbidly obese versus non-obese patient cohorts. Eight of the 11 studies reported increased complication rates in morbidly obese patients. Of the 13 studies, 9 had documented outcome scores in morbidly obese patients. All studies concluded that morbidly obese patients had the poorest overall preoperative and postoperative functional scores. Seven of the studies also documented the net gain in functional scores after THA between the morbidly obese and the non-morbidly obese groups. No difference was found between the groups. Morbidly obese patients undergo primary THA at a significantly younger age than non-obese patients. Furthermore, morbidly obese patients have a higher perioperative complication rate. Overall outcome measures are worse in the pre operative and the post operative phase in the short- and the medium-term follow-up time intervals. However, morbidly obese patients have similar functional gains as non-morbidly obese patients following THA.     

A comparison of outcomes in morbidly obese,obese and non-obese patients undergoing primary total knee and total hip arthroplasty

Background

Obesity is a growing public health issue with the prevalence of morbid obesity, (Body Mass Index (BMI) ≥ 40 kg/m²) increasing. There is some evidence these patients have more peri- and post-operative complications and poorer outcomes when undergoing arthroplasty procedures. This audit aimed to determine and compare the outcomes of non-obese, obese and morbidly obese patients undergoing arthroplasty at our institution.

Are Morbidly Obese Patients Equally Benefitting From Care Improvements in Total Hip Arthroplasty?

BackgroundMorbidly obese patients have increased rates of complications following primary total hip arthroplasty (THA) and it is not clear whether improvements in THA care pathways are equally benefitting these patients. The purpose of this study is to assess if reductions in complications have similarly improved for both morbidly obese and non-morbidly obese patients after THA.MethodsPatients undergoing primary THA between 2011 and 2019 were identified in the American College of Surgeons National Surgical Quality Improvement Program database. Patients were stratified by body mass index (BMI) <40 and ≥40 kg/m². Thirty-day rates of infectious complications, readmissions, reoperation, and any complication were assessed. Trends in complications were compared utilizing odds ratios and multivariate analyses.ResultsIn total, 234,334 patients underwent THA and 16,979 (7.8%) had BMI ≥40 kg/m². Patients with BMI ≥40 kg/m² were at significantly higher odds for readmission, reoperation, and infectious complications. Odds for any complication were lower for morbidly obese patients in 2011, not different from 2012 to 2014, and higher from 2015 to 2019 compared to lower BMI patients. Odds for any non-transfusion complication were higher for morbidly obese patients and there was no improvement for either group over the study period. There were improvements in rates of readmission and reoperation for patients with BMI <40 kg/m² and readmission for BMI >40 kg/m².ConclusionOdds for readmission and reoperation for non-morbidly obese patients and readmission for morbidly obese patients improved from 2011 to 2019. Reductions in transfusions are largely responsible for improvements in overall complication rates. Although morbidly obese patients remain at higher risk for complications, there does not appear to be a growing disparity in outcomes between morbidly obese and non-morbidly obese patients.     

Relationship Between Knee Anthropometry and Surgical Time in Total Knee Arthroplasty in Severely and Morbidly Obese Patients: A New Prognostic Index of Surgical Difficulty

BACKGROUND: Total knee arthroplasty (TKA) in patients with severe and morbid obesity is one of the current challenges in prosthetic knee surgery. The body mass index (BMI) is used to identify patients who may present difficulties during surgery and postoperative complications. We carried out a prospective study with an initial hypothesis that BMI is not associated with tourniquet time in obese patients undergoing TKA and that some anthropometric parameters may be useful in predicting tourniquet time in severely and morbidly obese patients. METHODS: One hundred consecutive patients diagnosed with knee osteoarthritis with BMI > or =35 kg/m(2) scheduled for TKA were prospectively studied. Suprapatellar, infrapatellar, and supra/infrapatellar anthropometric indexes were calculated before surgery. The tourniquet time was determined. RESULTS: The mean BMI was 39.81 kg/m(2) (SD +/- 3.75). A total of 58% of patients were classified as class III obesity (BMI 35-39.99) and 42% as class IV (BMI > or = 40) Mean tourniquet time was 41.67 min (SD +/- 9.26). There was no association between the BMI and tourniquet time. The suprapatellar index was negatively associated with tourniquet time (p < 0.038). DISCUSSION: The BMI is not the only parameter that should be considered in order to identify severely and morbidly obese patients who may have more surgical difficulties during TKA. Preoperative determination of the suprapatellar index helped us to classify these patients according to the morphology of the knee and predicted a longer tourniquet time and, therefore, greater surgical difficulty, in patients with a suprapatellar ratio below 1.6 in this study.     

Prevalence of sleep apnea in morbidly obese patients who presented for weight loss surgery evaluation: more evidence for routine screening for obstructive sleep apnea before weight loss surgery

The incidence of obstructive sleep apnea has been underestimated in morbidly obese patients who present for evaluation for weight loss surgery. This retrospective study shows that the incidence of obstructive sleep apnea in this patient population is greater than 70 per cent and increases in incidence as the body mass index increases. Obstructive sleep apnea (OSA) is a common comorbidity in obese patients who present for evaluation for gastric bypass surgery. The incidence of sleep apnea in obese patients has been reported to be as high as 40 per cent. A retrospective review of our prospectively collected database was performed. All patients being evaluated for weight loss surgery for obesity were screened preoperatively for OSA using a sleep study. The overall incidence of sleep apnea in our patients was 78 per cent (227 of 290). All 227 were diagnosed by formal sleep study. There were 63 (22%) males and 227 (78%) females. The mean age was 43 years (range, 17-75 years). The mean body mass index (BMI) was 52 kg/m2 (range, 31-94 kg/m2). The prevalence of OSA in the severely obese group (BMI 35-39.9 kg/m2) was 71 per cent. For the morbidly obese group (BMI 40-40.9 kg/m2), the prevalence was 74 per cent and for the superobese group (BMI 50-59.9 kg/m2) 77 per cent. Those with a BMI 60 kg/m2 or greater, the prevalence of OSA rose to 95 per cent. The incidence of sleep apnea in patients presenting for weight loss surgery was greater than 70 per cent in our study. Patients presenting for weight loss surgery should undergo a formal sleep study to diagnose OSA before bariatric surgery.     

Outcome Following Bariatric Surgery in Super versus Morbidly Obese Patients: Does Weight Matter?

Background: Numerous investigators have attempted to identify prognostic indicators for successful outcome following bariatric surgery. The purpose of this study was to determine whether degree of obesity affects outcome in super obese [>225% ideal body weight (IBW)] versus morbidly obese patients (160-225% IBW) undergoing gastric restrictive/bypass procedures. Methods: Since 1984, 157 patients underwent either gastric bypass or vertical banded gastroplasty. Super obese (78) and morbidly obese (79) patients were followed prospectively, documenting outcome and complications. Results: Super obese patients reached maximum weight loss 3 years following bariatric surgery, exhibiting a decrease in body mass index (BMI) from 61 to 39 kg/m² and an average loss of 42% excess body weight (EBW). Morbidly obese patients had a decrease in BMI from 44 to 31 kg/m² and carried 39% EBW at 1 year. After their respective nadirs, each group began to regain the lost weight with the super obese exhibiting a current BMI of 45 kg/m² (61% EBW) versus 34 kg/m² (52% EBW) in the morbidly obese at 72 months cumulative follow-up. Currently, loss of 50% or more of EBW occurred in 53% of super obese patients versus 72% of morbidly obese (P < 0.01). Twenty-six percent of super obese patients returned to within 50% of ideal body weight (IBW) while 71% of morbidly obese were able to reach this goal (P < 0.01). Co-morbidities and complications related to surgery were similar in each group. Conclusions: Super obese patients have a greater absolute weight loss after bariatric surgery than do morbidly obese patients. Using commonly utilized measures of success based on weight, morbidly obese patients tend to have better outcomes following bariatric surgery.     

Does BMI influence hospital stay and morbidity after fast-track hip and knee arthroplasty?

Background and purpose — Body mass index (BMI) outside the normal range possibly affects the perioperative morbidity and mortality following total hip arthroplasty (THA) and total knee arthroplasty (TKA) in traditional care programs. We determined perioperative morbidity and mortality in such patients who were operated with the fast-track methodology and compared the levels with those in patients with normal BMI.

Patients and methods — This was a prospective observational study involving 13,730 procedures (7,194 THA and 6,536 TKA operations) performed in a standardized fast-track setting. Complete 90-day follow-up was achieved using national registries and review of medical records. Patients were grouped according to BMI as being underweight, of normal weight, overweight, obese, very obese, and morbidly obese.

Results — Median length of stay (LOS) was 2 (IQR: 2–3) days in all BMI groups.

30-day re-admission rates were around 6% for both THA (6.1%) and TKA (5.9%), without any statistically significant differences between BMI groups in univariate analysis (p > 0.4), but there was a trend of a protective effect of overweight for both THA (p = 0.1) and TKA (p = 0.06).

90-day re-admission rates increased to 8.6% for THA and 8.3% for TKA, which was similar among BMI groups, but there was a trend of lower rates in overweight and obese TKA patients (p = 0.08 and p = 0.06, respectively). When we adjusted for preoperative comorbidity, high BMI in THA patients (very obese and morbidly obese patients only) was associated with a LOS of >4 days (p = 0.001), but not with re-admission. No such relationship existed for TKA.

Interpretation — A fast-track setting resulted in similar length of hospital stay and re-admission rates regardless of BMI, except for very obese and morbidly obese THA patients.     

Super Obesity Is an Independent Risk Factor for Complications After Primary Total Hip Arthroplasty

Background

Recent studies have reported higher postoperative complication rates in obese and morbidly obese patients undergoing total hip arthroplasty (THA). Less data are available regarding super-obese (body mass index [BMI] >50 kg/m²) patients. This study aims to quantify the risk of complications after THA in super-obese patients on a national scale and to put these risks in context by comparing them to patients of other BMI classes as well as those undergoing revision THA.

Do Extended Oral Postoperative Antibiotics Prevent Early Periprosthetic Joint Infection in Morbidly Obese Patients Undergoing Primary Total Joint Arthroplasty?

BackgroundExtended oral antibiotic prophylaxis after primary total knee arthroplasty (TKA) and total hip arthroplasty (THA) in patients with body mass index (BMI) ≥40 kg/m² may reduce the rate of early periprosthetic joint infection (PJI); however, existing data are limited. The purpose of this study was to examine rates of wound complications and PJI in patients with BMI ≥40 kg/m² treated with and without extended oral antibiotic prophylaxis after surgery.MethodsWe retrospectively identified all primary THA and TKA performed since 2015 in patients with a BMI ≥40 kg/m² at a single institution. Extended oral antibiotic prophylaxis for 7-14 days after surgery was prescribed at the discretion of each surgeon. Wound complications and PJI were examined at 90 days postoperatively.ResultsIn total, 650 cases (205 THA and 445 TKA) were analyzed. Mean age was 58 years and 62% were women. Mean BMI was 44 kg/m². Extended oral antibiotic prophylaxis was prescribed in 177 cases (27%). At 90 days, there was no difference between prophylaxis and nonprophylaxis groups in rate of wound complications (11% vs 8%; P = .41) or PJI (1.7% vs 0.6%; P = .35). The univariate analysis demonstrated increased operative time (odds ratio (OR) 1.01; 95% confidence interval (95% CI) 1.01-1.02) and diabetes mellitus (OR 1.88; 95% CI 1.03-3.46) to be associated with increased risk of 90-day wound complications. No patient factors were associated with increased risk of PJI at 90 days postoperatively.ConclusionExtended oral antibiotic prophylaxis after primary THA and TKA did not reduce rates of wound complications or early PJI in a morbidly obese patient population.