Findings of a recently published systematic review in The Bone and Joint Journal has demonstrated that bariatric surgery prior to total hip or total knee replacement does not improve the final clinical outcomes.
Osteoarthritis is one of the most disabling diseases worldwide. It is now proved that obesity, which itself is a common condition, is a predisposing factor for knee and hip osteoarthritis. On the other hand, osteoarthritis reduces the activity levels of patients causing obese patients to hardly lose weight.
Previous publications have reported a poorer outcome after various surgeries in obese patients; these complications may range from a delayed wound healing to more serious complications like myocardial infarctions and deep vein thrombosis. Obese patients also have a poorer prognosis after arthroplasties (surgeries that repair or replace a joint).
Although the effect of weight reduction on postoperative outcomes is well proved, the possible favorable impacts of bariatric surgeries (also known as weight loss surgeries) on postoperative complications and outcomes of arthroplasty are now questioned.
A new article has evaluated the effect of bariatric surgery on the outcomes of total knee and hip replacements in the form of a systematic review.
The present systematic review has evaluated published and unpublished clinical trials until November 5th 2015. All of these included publications compared the outcomes of arthroplasty with a prior bariatric surgery or those without prior bariatric surgery, for an incidence rate of wound infection, deep vein thrombosis, pulmonary embolism revision surgery and mortality.
A total of 156 papers were identified through the primary search of databases. From these, 5 non-randomized controlled trials were included in the final analysis. These 5 papers have evaluated and compared 657 patients with any kind of bariatric surgery prior to arthroplasty and 22,691 patients who did not have bariatric surgery before the arthroplasty. A total of 2709 patients underwent total hip replacement and 20,636 underwent total knee replacement.
The mean BMI of patients in the bariatric cohort was 36.1 kg/m2 comparing to 42.9 kg/m2 in the non-bariatric cohort.
Based on the findings, there was no statistically significant difference in outcomes including wound infection, deep vein thrombosis, pulmonary embolism, mortality, and revision surgery between the patients with prior bariatric surgery and patients without prior bariatric surgery.
The authors have concluded that bariatric surgery prior to total hip replacement or total knee replacement does not significantly reduce the rate of post-operative complications. The findings also do not support the role of bariatric surgeries on improving positive long-term outcomes.
Written By: Nima Makhdami, M.D.