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

Abstract

BackgroundPatients with morbid obesity may require both bariatric surgery and total knee/hip arthroplasty (TKA/THA). How to sequence these two procedures with better outcomes remains largely unstudied.MethodsThis cohort study extracted claims data on patients with an obesity diagnosis that received both bariatric surgery and TKA/THA surgery within 5 years of each other (Premier Healthcare database 2006–2019). Overall, 1894 patients received bariatric surgery before TKA or THA, while 1000 patients underwent TKA or THA before bariatric surgery. Main outcomes and measures include major complications (acute renal failure, acute myocardial infarction, other cardiovascular complications, sepsis/septic shock, pulmonary complications, pulmonary embolism, pneumonia, and central nervous system-related adverse events), postoperative intensive care unit utilization, ventilator utilization, 30-day readmission, 90-day readmission, 180-day readmission and total hospital length of stay after the second surgery. Regression models measured the association between the complications and sequence of TKA/THA and bariatric surgery.ResultsUndergoing TKA/THA before bariatric surgery (compared with the reverse) was associated with higher odds of major complications (7.0% vs 1.9%; adjusted OR 4.8, 95% CI 3.1, 7.6, p<0.001). Similar patterns were also observed for intensive care unit admission, ventilator use postoperatively, 30-day, and 90-day readmissions. Patients who received a second surgery within 6 months of their first surgery exhibited worse outcomes, especially among the TKA/THA first patient cohort. Major complication incidences occurred at 20.5%, 12.5%, 5.1%, 5.0%, 5.8% and 8.5% with time between TKA/THA and bariatric surgery at <6 months, 6 months–1 year, 1–2, 2–3, 3–4 and 4–5 years, respectively.ConclusionsPatients who require both bariatric surgery and TKA/THA should consider bariatric surgery before TKA/THA as it is associated with improved outcomes. Procedures should be staged beyond 6 months.

A 7-Year Study of the Durability of Improvements in Pain, Physical Function, and Work Productivity After Roux-en-Y Gastric Bypass and Sleeve Gastrectomy

“…Prior to surgery, 30% of participants had undergone ankle, knee, hip, or back surgery. However, bariatric surgical procedures have consistently been shown to improve joint arthroplasty outcomes, and it is likely that some participants who needed joint arthroplasty or another orthopedic surgery were ineligible due to a BMI criterion (eg, <40) . In this study, we did not assess desire or need for orthopedic surgeries prior to RYGB or SG or the outcomes of such surgeries.…”

Role of bariatric surgery in reducing periprosthetic joint infections in total knee arthroplasty. A systematic review and meta-analysis

“…Nevertheless, obese patients suffers more often than non-obese patients of knee osteoarthritis, leading to a surgical indication to knee replacement. Due to this paradoxical situation, in Literature are becoming more commons studies comparing TKA outcomes in obese patients treated with bariatric surgery and obese patients without BS [ 19 – 26 ]. Existing reviews of the literature about this topic [ 27 , 28 ] consider mechanical failures and re-admissions into the Hospital for early complications as main endpoints, without focusing on infectious complications.…”

Glucagon-like Peptide-1 Agonists

“…To this end, there are mixed views on whether bariatric surgery should be pursued before TJA and, if so, when. Multiple studies report improved outcomes or decreased risk of readmission due to any cause in patients undergoing TJA >6 months after bariatric surgery compared with those undergoing TJA <6 months after surgery 103,104 . These findings may be explained by the period of catabolic weight loss and malnourishment occurring after bariatric surgery.…”