Dislocation rate increases with bariatric surgery before total hip arthroplasty

Area of Science:

• Orthopedic Surgery
• Bariatric Surgery
• Health Services Research

Background:

• Annually, 113,000 patients with refractory obesity undergo bariatric surgery (BS) in the USA.
• A subset of these patients opts for BS to lower BMI and become better candidates for total hip arthroplasty (THA).

Purpose of the Study:

• To evaluate the risk of total hip arthroplasty (THA) complications in patients who underwent bariatric surgery (BS) prior to THA.
• To compare THA complication rates between patients with prior BS and control groups (obese and normal weight) without BS.

Main Methods:

• A claim-based review of the Medicare database identified 12,160 patients.
• Patients were categorized into three groups: prior BS (Group I), obese without BS (Group II), and normal weight without BS (Group III).
• Preoperative factors and short-term (30-day) and long-term (90-day, 2-year) complications were analyzed.

Main Results:

• Group I (prior BS) showed a higher incidence of deficiency anemia, cardiovascular disease, liver disease, diabetes, polysubstance abuse, psychiatric disorders, and smoking.
• At two years, Group I had double the risk of dislocation and revision compared to Groups II and III.
• Groups I and II had over four times the risk of infection and wound complications compared to Group III.

Conclusions:

• Patients undergoing THA after BS in the Medicare population exhibit complication rates similar to or greater than obese patients without prior BS.
• Increased dislocation risk may stem from ligamentous laxity or intraoperative visualization challenges.
• These findings highlight persistent risks for THA patients with a history of bariatric surgery.