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

Arani, Perna Ighani; Wretenberg, Per; Ottosson, Johan; Robertsson, Otto; W‐Dahl, Annette

doi:10.1080/17453674.2020.1840829

Cited by 15 publications

(10 citation statements)

References 31 publications

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“…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. Kulkarni et al studied the National Health Service database of the UK between 2005 and 2009, with 53 patients receiving BS first and 90 patients undergoing arthroplasty first.…”

Section: Discussionmentioning

confidence: 99%

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

Liu

Zhong

Poeran

et al. 2021

Reg Anesth Pain Med

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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.

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Section: Discussionmentioning

confidence: 99%

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

Liu

Zhong

Poeran

et al. 2021

Reg Anesth Pain Med

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“…We used a subset of a cohort including patients who underwent primary gastric bypass or sleeve gastrectomy (BS) in 2007-2019 identified from the Scandinavian Obesity Surgery Register (SOReg) and patients having primary TKA for OA in 2009-2019 within 2 years after their BS, and patients without prior BS from the Swedish Knee Arthroplasty Register (SKAR). As previously described, we used the BMI prior to the TKA in the BS group, and selected the no BS patients within the same BMI interval (range 16.9-50) and age interval (41.9-67 years) as the BS group [7]. The SOReg was established in 2007 and the SKAR in 1975.…”

Section: Methodsmentioning

confidence: 99%

“…patient-reported outcome (PRO), such as pain and knee function, have demonstrated varying results [5,6]. Our previous findings did not indicate that having a BS prior to TKA was associated with lower risk of revision [7]. Over time, the proportion of patients with obesity undergoing TKA has steadily been increasing [8].…”

Section: Introductionmentioning

confidence: 90%

“…We have recently published a study demonstrating that patients with BS prior to TKA had an increased risk of revision due to infection, compared to patients without prior BS. The control group consisted of patients within the same BMI range before their TKA [7]. Consequently, it is of clinical interest to determine if these patients were less satisfied regarding pain and ADL function one year after TKA.…”

Section: Introductionmentioning

confidence: 99%

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Pain, Function, and Satisfaction After Total Knee Arthroplasty, with or Without Bariatric Surgery

et al. 2022

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Background The impact of obesity on patient-reported outcome (PRO) after total knee arthroplasty (TKA) surgery has demonstrated varying results. We evaluated knee pain, Activity in Daily Life function (ADL), and satisfaction after TKA surgery in patients with and without prior bariatric surgery (BS). Methods Scandinavian Obesity Surgery Registry (SOReg) and the Swedish Knee Arthroplasty Register (SKAR) were used to identify patients operated on with primary TKA for osteoarthritis (OA) between 2009 and 2019 that had a BS within 2 years before the TKA (BS group). These patients were compared to patients with TKA without prior BS (no BS group). The patients filled in the Knee injury and Osteoarthritis Outcome Score (KOOS) preoperatively and one year postoperatively as well as satisfaction with the surgery one year postoperatively. Multiple linear regression analysis was used to evaluate 1-year postoperative KOOS pain and ADL function between the 2 groups. Adjustments were made for sex, age, and preoperative KOOS pain and ADL function respectively. Results Forty-four patients were included in the BS group and 3,525 patients in the no BS group. We found no statistically or clinically significant difference in one-year postoperative KOOS pain and ADL function between the BS group and the no BS group. The majority of the patients in both groups were classified as satisfied or very satisfied one year postoperatively to the TKA. Conclusions Our results indicate that patients without BS prior to the TKA gain similar 1-year outcome in pain, ADL function and satisfaction as patients with prior BS. Graphical abstract

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“…However, it is noted that any approach to reducing weight is controversial 28 and weight loss may not always result in adequate risk reduction. 27 , 29 …”

Section: Recommendationsmentioning

confidence: 99%

EFORT recommendations for off-label use, mix & match and mismatch in hip and knee arthroplasty

Tucker¹,

Günther

Kjærsgaard‐Andersen

et al. 2021

EFORT Open Reviews

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Off-label use is frequently practiced in primary and revision arthroplasty, as there may be indications for the application of implants for purposes outside the one the manufacturers intended. Under certain circumstances, patients may benefit from selective application of mix & match. This can refer to primary hip arthroplasty (if evidence suggests that the combination of devices from different manufacturers has superior results) and revision hip or knee arthroplasty (when the exchange of one component only is necessary and the invasiveness of surgery can be reduced). Within the EFORT ‘Implant and Patient Safety Initiative’, evidence- and consensus-based recommendations have been developed for the safe application of off-label use and mix & match in primary as well as revision hip and knee arthroplasty. Prior to the application of a medical device for hip or knee arthroplasty off-label and within a mix & match situation, surgeons should balance the risks and benefits to the patient, obtain informed consent, and document the decision process appropriately. Nevertheless, it is crucial for surgeons to only combine implants that are compatible. Mismatch of components, where their sizes or connections do not fit, may have catastrophic effects and is a surgical mistake. Surgeons must be fully aware of the features of the components that they use in off-label indications or during mix & match applications, must be appropriately trained and must audit their results. Considering the frequent practice of off-label and mix & match as well as the potential medico-legal issues, further research is necessary to obtain more data about the appropriate indications and outcomes for those procedures. Cite this article: EFORT Open Rev 2021;6:982-1005. DOI: 10.1302/2058-5241.6.210080

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

Abstract: (2020): Bariatric surgery prior to total knee arthroplasty is not associated with lower risk of revision: a register-based study of 441 patients, Acta Orthopaedica,

Cited by 15 publications

References 31 publications

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

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

Pain, Function, and Satisfaction After Total Knee Arthroplasty, with or Without Bariatric Surgery

EFORT recommendations for off-label use, mix & match and mismatch in hip and knee arthroplasty

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