The Effect of Bariatric Surgery Prior to Lower-Extremity Total Joint Arthroplasty: A Systematic Review

Abstract

Background Obesity is an independent risk factor for osteoarthritis and has been associated with increased rate of complications following lower-extremity total joint arthroplasty (TJA). Bariatric surgery (BS) is a surgical option for weight loss and for reducing obesity-related comorbidities in morbidly obese patients. Purpose/Questions The goal of this systematic review was to answer the following questions: (1) Does BS prior to TJA correlate with lower post-operative complication rates in morbidly obese patients undergoing TJA? (2) Does BS have an impact on revision rates following TJA? Methods Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and checklist, a systematic review of medical databases (PubMed/ MEDLINE, Cochrane Library, Web of Science, and Clinicaltrials.gov ) was undertaken for articles published in English from January 1990 to September 2018. Inclusion criteria were studies that included at least ten patients who underwent BS prior to TJA, collected data on complications or other outcomes, and followed patients for at least 90 days after TJA. A descriptive and critical analysis of the results was performed. Results From 799 studies, 13 met inclusion criteria. A total of 11,770 patients who had undergone bariatric surgery prior to TJA were analyzed. The quality of the evidence ranged between moderate and high. There was no consensus on the effect of previous BS on early- to short-term outcomes reported after TJA. Conclusion The literature remains conflicted on the impact of BS prior to TJA on early, short-term, and long-term complications after TJA. Additional well-matched, observational studies may further our understanding of the impact of BS prior to TJA on outcomes. In particular the effect of various types of BS prior to TJA on outcomes has yet to be elucidated. Ideally, prospective studies with higher level of evidence will be more definitive on the effects of BS prior to TJA. Prospero Registration Number: CRD42016043025. Electronic supplementary material The online version of this article (10.1007/s11420-019-09674-2) contains supplementary material, which is available to authorized users.

Bariatric surgery and total knee/hip arthroplasty: an analysis of the impact of sequence and timing on outcomes

“…14 A third meta-analysis by Gu et al, including 13 studies, could not reach consensus on the effect of BS before TKA/THA on both short-term and long-term complications. 1 In addition, a recent Swedish registry data analysis of 441 patients showed a higher infection-related revision risk among those that first received BS (HR 2.2, 95% CI 1.1 to 4.7). 15 As evidence indicates that BS before TKA/THA may not be effective in reducing perioperative complications, the question arises if patients in need of both BS and TKA/THA should undergo BS first.…”

“…Morbid obesity (body mass index >40 kg/m 2 ) is increasingly common among surgical candidates for total knee/hip arthroplasty (TKA/THA). 1 These patients carry a higher comorbidity burden and are at risk for worse surgical outcomes. 2 Preoperative health optimization programs have been implemented to reduce overall postoperative complications which include preoperative weight loss with some patients with obesity referred to bariatric surgery (BS) before TKA/THA surgery.…”

Should isolated morbid obesity influence the decision to operate in hip and knee arthroplasty?

“…Bariatric surgery does carry many benefits in reduction of pain in OA of the hip, knee, and spine after successful weight loss, but these are quite separate from improvements in outcomes after total joint arthroplasty. 29 , 30 Although bariatric surgery is provided by the NHS and approved by the National Institute for Health and Clinical Excellence, 31 it is not universally available in all parts of the UK.…”

Bariatric surgery prior to total knee arthroplasty is not associated with lower risk of revision: a register-based study of 441 patients

“…BS that may reduce BMI and subsequently comorbidities prior to a TKA could then be a beneficial measure to reduce the risk of revision. Nevertheless, this remains unclear considering previous studies (Inacio et al 2014, Martin et al 2015, McLawhorn et al 2018 as well as in a recent systemic review (Gu et al 2019).…”