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Lingering Risk: Bariatric Surgery Before Total Knee Arthroplasty
Brian T Nickel1, Mitchell R Klement1, Colin T Penrose1
1Department of Orthopaedic Surgery, Duke University School of Medicine.
The Journal of Arthroplasty
|May 16, 2016
Summary
Bariatric surgery before total knee arthroplasty increases complication risks compared to nonobese and obese patients. This highlights the need for careful patient selection and management in bariatric surgery patients undergoing knee replacement.
Area of Science:
- Orthopedic Surgery
- Bariatric Surgery
- Health Services Research
Background:
- Rising obesity rates in the US present challenges for elective surgeries like total knee arthroplasty.
- Bariatric surgery (BS) is increasingly common, but its timing relative to arthroplasty remains debated.
- No established consensus exists regarding the optimal sequence of BS and total knee arthroplasty (TKA).
Purpose of the Study:
- To investigate the complication rates associated with total knee arthroplasty (TKA) in patients who underwent bariatric surgery (BS) prior to TKA.
- To compare these complication rates against obese patients without BS and normal-weight controls.
- To inform clinical decision-making on the timing of BS in relation to TKA.
Main Methods:
- A retrospective analysis of 39,014 Medicare beneficiaries using International Classification of Diseases, Ninth Revision codes.
- Patients were categorized into three groups: BS before TKA (Group I), obese without BS (Group II), and normal weight (Group III).
- Preoperative demographics, comorbidities, and short-term (30-day) and long-term (90-day, 2-year) medical and surgical complications were evaluated.
Main Results:
- Group I (BS before TKA) exhibited higher rates of deep vein thrombosis, pneumonia, and heart failure compared to controls.
- Long-term complication rates for infection, revision, and manipulation at 2 years were significantly elevated in Group I versus Group III and slightly higher than Group II.
- Group I patients had greater female predominance, younger age, and higher incidence of anemia, cardiovascular, pulmonary, liver, ulcer, substance abuse, psychiatric, and smoking-related comorbidities.
Conclusions:
- Bariatric surgery preceding total knee arthroplasty is linked to increased medical and surgical risks.
- Potential contributing factors include higher comorbidity burden, wound healing issues, malnutrition, rapid weight loss, and age.
- These findings underscore the importance of careful preoperative assessment and management for patients undergoing TKA after BS.
