Effect of Bariatric Surgery on Risk of Complications After Total Knee Arthroplasty

Abstract

Key Points Question Does bariatric surgery reduce complication risk after total knee arthroplasty (TKA) in patients with severe obesity? Findings In this randomized clinical trial of 82 adults aged 65 years and younger with class II obesity, those who were scheduled to undergo TKA experienced fewer joint surgery complications after undergoing a bariatric procedure, compared with those who underwent TKA without weight loss intervention. Meaning The findings suggest that people with severe obesity and knee osteoarthritis should seek to lose weight before considering TKA, and weight loss appears to reduce the complications of joint surgery.

2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) Indications for Metabolic and Bariatric Surgery

“…In a median follow-up of 2 years after TKA, 14.6% of patients in the MBS group incurred the primary outcome of composite complications, compared with 36.6% in the control (non-MBS) group (difference 22.0%, P = .02). Interestingly, TKA was declined by 29.3% of subjects in the MBS group because of symptom improvement following weight loss, compared with only 4.9% in the control group [ 73 ].…”

Total Knee Arthroplasty and Bariatric Surgery: Change in BMI and Risk of Revision Depending on Sequence of Surgery

“…However, 2/41 patients did not have BS prior to their TKA, and 12/41 did not undergo any TKA in the intervention group, but were still included in the intention to treat analysis. Furthermore, the majority of the patient in the intervention group had undergone gastric banding which differ from the patients in our BS group [14].…”

Information and BMI limits for patients with obesity eligible for knee arthroplasty: the Swedish surgeons’ perspective from a nationwide cross-sectional study

“…Bariatric surgery (BS) has been shown to be the most effective method in achieving significant long-term weight loss for patients with obesity in comparison with nonsurgical interventions [ 25 ]. A recent randomized control trial, analyzing the weight change after TKA in patients with prior BS or not, demonstrated that 12 of the 41 patients who had received BS did no longer require a TKA since their symptoms had improved [ 26 ]. The question arises if we should routinely recommend patients with obesity that fail to lose weight through other methods, the possibility to perform BS prior to their knee arthroplasty.…”