[Orthopedic interventions after metabolic and bariatric surgery]

Overweight and obesity are among the leading causes of degenerative musculoskeletal disorders. As a consequence, the proportion of obese patients undergoing knee or hip joint arthroplasty or spinal surgery has significantly increased. In these interventions obese patients are at a higher risk for perioperative complications, including thromboembolic events, wound healing disorders, periprosthetic infections, implant failure and the need for revision surgery. A body mass index (BMI) >40 kg/m² is considered a contraindication for many elective orthopedic procedures. Bariatric surgery can lead to rapid and sustained weight loss; however, the metabolic changes induced by these procedures can affect the absorption and bioavailability of nutrients and medications. At the same time, the altered metabolic state following bariatric surgery is associated with an increased risk of perioperative complications during orthopedic interventions. Furthermore, the efficacy of medications, such as analgesics, antimicrobial agents and oral anticoagulants can be significantly altered by metabolic and bariatric procedures. This article provides an overview of the specific considerations for orthopedic procedures following metabolic and bariatric surgery.