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

Abstract

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

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

“…Another Swedish study found that the majority of both patients with or without prior BS to TKA were satisfied or very satisfied after their TKA and found no difference in one-year postoperative pain or ADL function to TKA between the two cohorts. However, the analysis was adjusted for BMI before TKA in the patients with prior BS to TKA [ 35 ]. Furthermore, a study from 2019 did not find any difference in improvement in PROs one year after TKA depending on the BMI [ 36 ].…”

Results from the Scandinavian Obesity Surgery Registry: A narrative review

“…Bariatric surgery does however not seem to convey decreased risk for reoperation after total knee replacement surgery for the first 2 years, 67 although providing identical outcome in pain relief, activities of daily living function, and satisfaction. 68 Unfortunately, gastric bypass surgery seems to be associated with an increased risk for fractures and an overall risk for fall injuries without fractures. 69 In these cohort studies, there was no clear association between the risk for fractures and the degree of substitution and vitamin D and calcium after surgery.…”

“…Obesity is associated with arthrosis in the knee joints. Bariatric surgery does however not seem to convey decreased risk for reoperation after total knee replacement surgery for the first 2 years, 67 although providing identical outcome in pain relief, activities of daily living function, and satisfaction 68 . Unfortunately, gastric bypass surgery seems to be associated with an increased risk for fractures and an overall risk for fall injuries without fractures 69 .…”

Effect of Intravenous Zoledronic Acid on Total Knee Replacement in Patients With Symptomatic Knee Osteoarthritis and Without Severe Joint Space Narrowing: A Prespecified Secondary Analysis of a Two‐Year, Multicenter, Double‐Blind, Placebo‐Controlled Clinical Trial

“…2 are dissatisfied with their postoperative outcome. 3,5,6 Therefore, new treatments are needed to delay the progression of knee osteoarthritis.…”

“…However, total knee replacement is expensive and up to 20% of patients experience long‐term pain after total knee replacement 4 . Moreover, recent studies show that approximately 7% to 20% of patients are dissatisfied with their postoperative outcome 3,5,6 . Therefore, new treatments are needed to delay the progression of knee osteoarthritis.…”