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Prior bariatric surgery may decrease the rate of re-operation and revision following total hip arthroplasty
C D Watts1, J R Martin2, M T Houdek1
1Mayo Clinic, 200 1st St GW Gonda 14S, Rochester, MN 55905, USA.
Insights
Obese patients who had bariatric surgery experienced fewer re-operations and revisions after total hip arthroplasty (THA). Prior bariatric surgery appears beneficial for THA outcomes in this population.
Area of Science:
- Orthopedic Surgery
- Bariatric Surgery
- Obesity Management
Background:
- Obesity is a significant risk factor for complications following total hip arthroplasty (THA).
- Bariatric surgery leads to substantial weight loss, potentially altering surgical outcomes.
- The impact of prior bariatric surgery on THA outcomes in obese patients remains under investigation.
Purpose of the Study:
- To compare the outcomes of total hip arthroplasty (THA) in obese patients who underwent bariatric surgery versus those who did not.
- To assess the risks of re-operation and revision after THA in these two groups.
Main Methods:
- A matched cohort study design was employed.
- The study included 47 THAs in the bariatric group and 94 THAs in the comparison group.
- Mean follow-up after THA was three years.
Main Results:
- Patients in the bariatric group showed a significant improvement in Body Mass Index (BMI) after bariatric surgery (from 49.7 kg/m² to 35.3 kg/m²).
- The comparison group had a significantly increased risk of re-operation (HR 3.2) and revision (HR 5.4) compared to the bariatric group.
- These findings were statistically significant (p < 0.01).
Conclusions:
- Prior bariatric surgery is associated with a dramatic improvement in BMI and a lower risk of re-operation and revision after THA in the short- to mid-term.
- While promising, larger prospective studies are needed to confirm these findings and guide clinical recommendations.
- The study suggests potential benefits of staged bariatric surgery followed by THA in obese patients.
Aims:
We compared the outcome of total hip arthroplasty (THA) in obese patients who previously underwent bariatric surgery and those who did not, in a matched cohort study.
Patients And Methods:
There were 47 THAs in the bariatric group (42 patients), and 94 THAs in the comparison group (92 patients). The mean age of the patients was 57 years in both groups (24 to 79) and 57% of the patients in both groups were women. The mean time between bariatric surgery and THA was five years (four months to 12 years) in the bariatric group. The mean follow-up after THA was three years (2 to 9).
Results:
The mean BMI improved from 49.7 kg/m(2) (35 to 75) prior to bariatric surgery to 35.3 kg/m(2) (21 to 49) at the time of THA (p < 0.001). Patients in the comparison group had an increased risk of re-operation (Hazard Ratio (HR) 3.2; 95% confidence intervals (CI) 1.3 to 9.5, p = 0.01) and revision (HR 5.4; 95% CI 1.5 to 34.5, p = 0.01) when compared with the bariatric group.
Conclusion:
Patients had a dramatic improvement in BMI after bariatric surgery and those with prior bariatric surgery had a lower risk of re-operation and revision in the short- and mid-term after a subsequent THA. Larger prospective studies are required before it can be concluded that this extra surgery should be advised in these patients. Cite this article: Bone Joint J 2016;98-B:1180-4.
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