Total Knee Arthroplasty With or Without Prior Bariatric Surgery: A Systematic Review and Meta-Analysis

Area of Science:

• Orthopedic Surgery
• Bariatric Surgery
• Medical Complications

Background:

• Obese patients undergoing total knee arthroplasty (TKA) have varied outcomes when compared to those who have had bariatric surgery prior to TKA.
• This systematic review and meta-analysis aims to compare TKA outcomes with and without preceding bariatric surgery in obese individuals.

Purpose of the Study:

• To compare the outcomes of total knee arthroplasty (TKA) in obese patients who underwent bariatric surgery prior to TKA versus those who underwent TKA alone.
• To evaluate the impact of bariatric surgery on medical and surgical complications, revision rates, and mortality associated with TKA.

Main Methods:

• A systematic search of MEDLINE, PubMed, and Embase was conducted up to April 9, 2023.
• Twelve studies comprising 2,876,547 patients (62,818 with prior bariatric surgery, 2,813,729 without) were included.
• Primary outcomes included medical complications (e.g., VTE, stroke), surgical complications, revision, and mortality; secondary outcomes included blood transfusion, length of stay, and readmission.

Main Results:

• Patients undergoing bariatric surgery before TKA demonstrated significantly lower odds of 90-day venous thromboembolism (VTE) (OR=0.75) and 90-day stroke (OR=0.58).
• A reduced risk of 1-year periprosthetic fracture (OR=0.74) was also observed in the bariatric surgery group.
• While hospital stays were shorter by 0.19 days, this difference was not clinically significant. Other outcomes were comparable between groups.

Conclusions:

• Bariatric surgery preceding TKA offers significant benefits by lowering the risk of VTE, stroke, and periprosthetic fractures in obese patients.
• Surgeons should consider discussing bariatric surgery as a potential pre-TKA intervention for obese patients, particularly those at high risk for VTE and stroke.