Does Bariatric Surgery Prior to Primary Total Knee Arthroplasty Improve Outcomes?

Preoperative and Postoperative Weight Change has Minimal Influence on Health Care Utilization and Patient-Reported Outcomes Following Total Knee Arthroplasty

“…Results have shown that bariatric surgery leading to a reduction in weight prior to TKA is associated with a reduced risk of complications (p=0.02) [34], decreased LOS (p<0.001) [35], and a reduced risk of delayed discharge, wound complications, periprosthetic infection, and readmission [36]. Other study results display no difference in early complications [35], late reinterventions [35], or 90-day readmission rates comparing patients who did versus did not undergo bariatric surgery [37]. Yet some studies even report a greater risk of revision (Hazard Ratio=4, p<0.01) [37] and markedly elevated risk of complications in bariatric surgery patients following TKA [38].…”

“…Although there is no consensus on the associations between bariatric surgery and TKA outcomes, it is worth noting that several studies reported a significant number of patients electing to not undergo TKA after bariatric surgery due to improvement in osteoarthritis symptoms [34,36]. It is important to note that bariatric surgery and its effects on BMI and weight loss leads to additional confounding variables such as the type of bariatric surgery performed and the timing of the procedure in relation to TKA [37,38]. The strategy used for weight loss is outside the scope of the current study.…”

In Patients with Knee OA and Severe Obesity, Bariatric Surgery and Weight Loss Before TKA Reduced Complications Versus TKA Alone

“…There is conflicting evidence about the need for and timing of bariatric surgery in relation to arthroplasty surgery. Studies comparing bariatric surgery versus no surgery in patients with obesity and lower (<40 kg/m 2 ) or higher (≥40 kg/m 2 ) BMI have shown reduced implant stability and survivorship 1,2 , whereas others have reported lower medical and surgical complication rates in patients who had previous bariatric surgery 3 . However, these studies relied on retrospective cohorts and large administrative data sets.…”

What’s New in Musculoskeletal Infection

“…Over the last few years, orthopaedic surgeons have made great progress in optimizing modifiable risk factors prior to arthroplasty, specifically with weight loss before the surgical procedure. With more patients undergoing bariatric surgery to optimize their weight, a recent study found that patients who underwent bariatric surgery actually had higher rates of reoperation for PJI after TKA relative to a matched cohort with high body mass index (BMI), suggesting that underlying malnutrition may play a role 13 . Likewise, patients who underwent bariatric surgery prior to THA had higher rates of implant failure and dislocation than patients with naturally low or high BMI 14 .…”