Professor Deborah (Debbie) Snell
Clinician Scientist, Burwood Hospital, Christchurch, NZ
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Deborah is a clinician scientist with a background in clinical and neuropsychology. Much of her clinical and research career has focused on improving rehabilitation outcomes for people living with musculoskeletal and neurological conditions, especially the psychological and psychosocial factors that influence those outcomes. She was one of the first researchers to systematically examine the impacts of theoretically derived models of health and illness behaviour on outcomes after concussion. This work spanning more than a decade has expanded to other health conditions and has explored psychological determinants of various outcomes, more latterly focusing on effective screening for psychological risk in rehabilitation services and building research evidence for treatment.
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Deborah also directs clinical trials at Burwood Hospital in Christchurch, investigating a range of outcomes after orthopaedic interventions, including post-surgical pain, psychosocial and quality of life improvements. She particularly values working with postgraduate students and collaborating with other health and rehabilitation researchers, clinicians and service users around Aotearoa and internationally.
What Does the Evidence Say About Hip Replacement Outcomes for People Living With Osteoarthritis and Obesity: Insights from a 10-Year Longitudinal Study
Hua Shin Tan1; Deborah Snell1,*; Jinny Willis1,2; Christopher Frampton 3; Gary Hooper1
1 Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago Christchurch, New Zealand
2 New Zealand Joint Registry, Christchurch, New Zealand
3 Department of Medicine, University of Otago Christchurch, New Zealand
Introduction: Total hip replacement (THR) is common, leading to reduced pain and improved function. The influence of obesity on outcomes is debated, with some centres adopting body mass index (BMI) cut-offs. This means some individuals are denied access to surgery based on their weight, despite evidence suggesting this may not be effective in incentivising weight loss.
Aims: To examine whether obesity and morbid obesity have an effect on pain and function outcomes up to 10 years after THR.
Methods: Prospective longitudinal study of people undergoing THR with a documented BMI at surgery (n=6959; n=781 with 10-year outcomes), at a single centre in Aotearoa New Zealand. Participants were stratified by BMI: non-obese (BMI <30); obese (BMI 30-<40); morbidly obese (BMI >= 40). Primary outcomes were change in pain and function up to 10 years after THR.
Results: There were no differences in pain and function change scores up to 10 years post-operatively between the three BMI-stratified groups. Although the obese groups had higher rates of revision/100 component years compared with the non-obese group, overall revision rates were low (3.1%).
Conclusions: A higher BMI alone should not be a reason to restrict obese and morbidly obese individuals from undergoing THR. Our findings show similar pain and function outcomes among participant groups up to 10 years after surgery. Surgeons can use this information to counsel obese and morbidly obese individuals preoperatively on the expected pain reduction and function enhancing outcomes associated with THR.
1 Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago Christchurch, New Zealand
2 New Zealand Joint Registry, Christchurch, New Zealand
3 Department of Medicine, University of Otago Christchurch, New Zealand
Introduction: Total hip replacement (THR) is common, leading to reduced pain and improved function. The influence of obesity on outcomes is debated, with some centres adopting body mass index (BMI) cut-offs. This means some individuals are denied access to surgery based on their weight, despite evidence suggesting this may not be effective in incentivising weight loss.
Aims: To examine whether obesity and morbid obesity have an effect on pain and function outcomes up to 10 years after THR.
Methods: Prospective longitudinal study of people undergoing THR with a documented BMI at surgery (n=6959; n=781 with 10-year outcomes), at a single centre in Aotearoa New Zealand. Participants were stratified by BMI: non-obese (BMI <30); obese (BMI 30-<40); morbidly obese (BMI >= 40). Primary outcomes were change in pain and function up to 10 years after THR.
Results: There were no differences in pain and function change scores up to 10 years post-operatively between the three BMI-stratified groups. Although the obese groups had higher rates of revision/100 component years compared with the non-obese group, overall revision rates were low (3.1%).
Conclusions: A higher BMI alone should not be a reason to restrict obese and morbidly obese individuals from undergoing THR. Our findings show similar pain and function outcomes among participant groups up to 10 years after surgery. Surgeons can use this information to counsel obese and morbidly obese individuals preoperatively on the expected pain reduction and function enhancing outcomes associated with THR.
