Bariatric Surgery Prior to Total Joint Arthroplasty May Not Provide Dramatic Improvements in Post-Arthroplasty Surgical Outcomes

Abstract

This study compared the total joint arthroplasty (TJA) surgical outcomes of patients who had bariatric surgery prior to TJA to TJA patients who were candidates but did not have bariatric surgery. Patients were retrospectively grouped into: Group 1 (n = 69), those with bariatric surgery >2 years prior to TJA, Group 2 (n = 102), those with surgery within 2 years of TJA, and Group 3 (n = 11,032), those without bariatric surgery. In Group 1, 2.9% (95% CI 0.0-6.9%) had complications within 1 year compared to 5.9% (95% CI 1.3%-10.4%) in Group 2, and 4.1% (95% CI 3.8%-4.5%) in Group 3. Ninety-day readmission (7.2%, 95% CI 1.1%-13.4%) and revision density (3.4/100 years of observation) was highest in Group 1. Bariatric surgery prior to TJA may not provide dramatic improvements in post-operative TJA surgical outcomes.

Low Albumin Levels, More Than Morbid Obesity, Are Associated With Complications After TKA

“…Benefits of TKA in populations at greater risk for complications are less well defined. Morbid obesity and malnutrition have been shown to be associated with increased perioperative complications after TKA [5,6,10,12,16,18,19,27,32]; however, some studies have not shown an increased risk of perioperative complications in patients who are morbidly obese [3,13,14,23,25]. In addition, patients with morbid obesity are more likely to be malnourished than patients who are not obese, raising the question whether morbid obesity, malnutrition, or both, are independently associated with increased perioperative complications [12].…”

“…There have been conflicting studies regarding the association of morbid obesity with increases in short-term and long-term complications after TKA [3,6,10,13,14,16,18,19,[23][24][25]. Multivariate analyses to determine specifically whether morbid obesity alone or other comorbid conditions such as malnutrition are the primary factors associated with the increased risk of complications were not performed in some of these studies.…”

“…Even with intensive and supervised programs involving diet, exercise, lifestyle modification, and/or bariatric surgery, in many cases sustained weight loss has not been achieved in patients with morbid obesity [13,29,30]. In addition, some studies have shown that complication rates after TKA in patients whom have undergone bariatric surgery are similar to complication rates for morbidly obese patients who did not undergo bariatric surgery [13,29]. We are not aware of any studies in orthopaedics evaluating whether preoperative correction of low serum albumin or nutritional indices results in a decrease in associated complications.…”

CORR Insights®: Do Stemmed Tibial Components in Total Knee Arthroplasty Improve Outcomes in Patients With Obesity?

“…It is difficult to infer a direct relationship between obesity and outcomes secondary to undergoing bariatric surgery due to the lack of a matched cohort controlling for many of the coexisting comorbidities. Others have noted either no difference or worse outcomes including higher reoperation and revision rates in patients that underwent bariatric surgery prior to TKA [8,10,12]. One explanation for inferior outcomes in the bariatric patient population undergoing TKA is the presence of concomitant malnutrition in this patient population [11].…”

CORR Insights®: Dual-mobility or Constrained Liners Are More Effective Than Preoperative Bariatric Surgery in Prevention of THA Dislocation

“…In fact, dislocations were more common in the postbariatric surgery group at 1 year than in the obese group (13 vs 6%). This is not the first paper to question the benefits of bariatric surgery in the total joint population, with multiple studies [2][3][4] showing no reduction in complications when patients with total joint underwent preoperative bariatric surgery.…”