Skip to main content
Log in

Bariatric Surgery Prior to Total Joint Arthroplasty, Does it Decrease the Risk of Obesity Related Perioperative Complications?

  • Surgery and Perioperative Care (S Goodman, Section Editor)
  • Published:
Current Rheumatology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The purpose of this review paper is to provide an overview of the relationship between obesity, osteoarthritis, arthroplasty outcomes, and the potential use of bariatric surgery to improve these outcomes.

Recent Findings

Unfortunately, the findings in the currently available literature evaluating the role of bariatric surgery prior to arthroplasty surgery largely rely on retrospective data and their results are somewhat conflicting.

Summary

Future prospective studies are needed to further evaluate whether or not bariatric surgery prior to arthroplasty surgery may be of benefit for patients. Additional research is needed to identify other methods to minimize complications that obese patients are particularly prone to developing following arthroplasty surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Obesity and overweight fact sheet. World Health Organization. Available from: http://www.who.int/mediacentre/factsheets/fs311/en/. Accessed June 2017.

  2. Flegal KM, Kruszon-Moran D, Carroll MD, et al. Trends in obesity among adults in the United States, 2005 to 2014. JAMA. 2016;315:21.

    Article  Google Scholar 

  3. Salih S, Sutton P. Obesity knee osteoarthritis and knee arthroplasty: a review. BMC Sports Sci Med Rehabil. 2013;5(1):25.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Springer BD, Carter JT, McLawhorn AS, Scharf K, Roslin M, Kallies KJ, et al. Obesity and the role of bariatric surgery in the surgical management of osteoarthritis of the hip and knee: a review of the literature. Surg Obes Relat Dis. 2017 Jan;13(1):111–8. https://doi.org/10.1016/j.soard.2016.09.011.

    Article  PubMed  Google Scholar 

  5. Cicuttini F, Baker J, Spector TD. The association of obesity with osteoarthritis of the hand and knee in women: a twin study. J Rheumatol. 1996;23:1221–6.

    CAS  PubMed  Google Scholar 

  6. Anandacoomarsamy A, Fransen M, Obesity ML. The musculoskeletal system. Curr Opin Rheumatol. 2009;21(1):71–7.

    Article  Google Scholar 

  7. Changulani M, Kalairajah Y, Peel T, et al. The relationship between obesity and the age at which hip and knee replacement is undertaken. J Bone Joint Surg Br. 2008;90:3.

    Google Scholar 

  8. Gandhi R, Wasserstein D, Razak F, Davey JR, Mahomed NN. BMI independently predicts younger age at hip and knee replacement. Obesity. 2010 Dec;18(12):2362–6. https://doi.org/10.1038/oby.2010.72.

    Article  PubMed  Google Scholar 

  9. Jamsen E, Nevalainen P, Eskelinen A, Huotari K, Kalliovalkama J, Moilanen T. Obesity, diabetes, and preoperative hyperglycemia as predictors of periprosthetic joint infection: a single-center analysis of 7181 primary hip and knee replacements for osteoarthritis. J Bone Joint Surg Am. 2012;94(14):e101–-9. https://doi.org/10.2106/JBJS.J.01935.

    Article  PubMed  Google Scholar 

  10. Namba RS, Paxton L, Fithian DC, Stone ML. Obesity and perioperative morbidity in total hip and total knee arthroplasty patients. J Arthroplasty. 2005;20(7 Suppl 3):46–50.

    Article  PubMed  Google Scholar 

  11. Liu W, Wahafu T, Cheng M, Cheng T, Zhang Y, Zhang X. The influence of obesity on primary total hip arthroplasty utcomes: a meta-analysis of prospective cohort studies. Orthop Traumatol Surg Res. 2015;101(3):289–96. https://doi.org/10.1016/j.otsr.2015.01.011.

    Article  CAS  PubMed  Google Scholar 

  12. Chee YH, Teoh KH, Sabnis BM, Ballantyne JA, Brenkel IJ. Total hip replacement in morbidly obese patients with osteoarthritis: results of a prospectively matched study. J Bone Joint Surg Br. 2010;92 (8):1066–71.

    Article  Google Scholar 

  13. Murgatroyd SE, Frampton CM, Wright MS. The effect of body mass index on outcome in total hip arthroplasty: early analysis from the New Zealand joint registry. J Arthroplast. 2014;29:10.

    Article  Google Scholar 

  14. Elson LC, Barr CJ, Chandran SE, Hansen VJ, Malchau H, Kwon YM. Are morbidly obese patients undergoing total hip arthroplasty at an increased risk for component malpositioning? J Arthroplast. 2013;28(8):41–4. https://doi.org/10.1016/j.arth.2013.05.035.

    Article  Google Scholar 

  15. Boido A, Ceriani V, Cetta F, Lombardi F, Pontiroli AE. Bariatric surgery and prevention of cardiovascular events and mortality in morbid obesity: mechanisms of action and choice of surgery. Nutr Metab Cardiovasc Dis. 2015 May;25(5):437–43. https://doi.org/10.1016/j.numecd.2015.01.011.

    Article  CAS  PubMed  Google Scholar 

  16. Bradley BM, Griffiths SN, Stewart KJ, et al. The effect of obesity and increasing age on operative time and length of stay in primary hip and knee arthroplasty. J Arthroplast. 2014;29:10.

    Article  Google Scholar 

  17. Järvenpää J, Kettunen J, Soininvaara T, Miettinen H, Kröger H. Obesity has a negative impact on clinical outcome after total knee arthroplasty. Scand J Surg. 2012;101(3):198–203. https://doi.org/10.1177/145749691210100310.

    Article  PubMed  Google Scholar 

  18. Belmont PJ Jr, Goodman GP, Waterman BR, Bader JO, Schoenfeld AJ. Thirty-day postoperative complications and mortality following total knee arthroplasty: incidence and risk factors among a national sample of 15,321 patients. J Bone Joint Surg Am. 2014;96(1):20–6. https://doi.org/10.2106/JBJS.M.00018.

    Article  PubMed  Google Scholar 

  19. Järvenpää J, Kettunen J, Kröger H, Miettinen H. Obesity May impair the early outcome of TKA. Scand J Surg. 2010;99(1):45–9.

    Article  PubMed  Google Scholar 

  20. • Abdel MP, Bonadurer GF 3rd, Jennings MT, Hanssen AD. Increased aseptic tibial failures in patients with a BMI ≥35 and well-aligned total knee arthroplasties. J Arthroplasty. 2015;30(12):2181–4. The results in this study indicate that obese patients are at increased risk of mechanical failure of their TKA implants, specifically of the tibial component.

    Article  PubMed  Google Scholar 

  21. Courcoulas AP, Yanovski SZ, Bonds D, Eggerman TL, Horlick M, Staten MA, et al. Long-term outcomes of bariatric surgery: a National Institutes of Health symposium. JAMA Surg. 2014;149(12):1323–9. https://doi.org/10.1001/jamasurg.2014.2440.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Courcoulas AP, Christian NJ, Belle SH, Berk PD, Flum DR, Garcia L, et al. Weight change and health outcomes at 3 years after bariatric surgery among individuals with severe obesity. JAMA. 2013;310(22):2416–25. https://doi.org/10.1001/jama.2013.280928.

    CAS  PubMed  PubMed Central  Google Scholar 

  23. Smith TO, Aboelmagd T, Hing CB, MacGregor A. Does bariatric surgery prior to total hip or knee arthroplasty reduce post-operative complications and improve clinical outcomes for obese patients? Systematic review and meta-analysis. Bone Joint J. 2016;98-B(9):1160–6. https://doi.org/10.1302/0301-620X.98B9.38024.

    Article  PubMed  Google Scholar 

  24. Kulkarni A, Jameson SS, James P, Woodcock S, Muller S, Reed MR. Does bariatric surgery prior to lower limb joint replacement reduce complications? Surgeon. 2011 Feb;9(1):18–21. https://doi.org/10.1016/j.surge.2010.08.004.

    Article  CAS  PubMed  Google Scholar 

  25. Nearing EE 2nd, Santos TM, Topolski MS, Borgert AJ, Kallies KJ, Kothari SN. Benefits of bariatric surgery before elective total joint arthroplasty: is there a role for weight loss optimization? Surg Obes Relat Dis. 2017;13(3):457–62. https://doi.org/10.1016/j.soard.2016.11.005.

    Article  PubMed  Google Scholar 

  26. • Werner BC, Kurkis GM, Gwathmey FW, Browne JA. Bariatric surgery prior to total knee arthroplasty is associated with fewer postoperative complications. J Arthroplasty. 2015;30(9 Suppl):81–5. This study analyzed the outcomes of a very large cohort of patients (>70,000), comparing outcomes based on obesity and pre-arthroplasty bariatric surgery status.

    Article  PubMed  Google Scholar 

  27. Watts CD, Martin JR, Houdek MT, Abdel MP, Lewallen DG, Taunton MJ. Prior bariatric surgery may decrease the rate of re-operation and revision following total hip arthroplasty. Bone Joint J. 2016;98-B(9):1180–4. https://doi.org/10.1302/0301-620X.98B9.37943.

    Article  CAS  PubMed  Google Scholar 

  28. Severson EP, Singh JA, Browne JA, Trousdale RT, Sarr MG, Lewallen DG. Total knee arthroplasty in morbidly obese patients treated with bariatric surgery a comparative study. J Arthroplasty. 2012;27(9):1696–700. https://doi.org/10.1016/j.arth.2012.03.005.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Inacio MC, Paxton EW, Fisher D, Li RA, Barber TC, Singh JA. Bariatric surgery prior to total joint arthroplasty may not provide dramatic improvements in post-arthroplasty surgical outcomes. J Arthroplast. 2014;29(7):1359–64. https://doi.org/10.1016/j.arth.2014.02.021.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Ethics declarations

Conflict of Interest

Dr. McLawhorn reports personal fees from Ethicon, personal fees from Intellijoint, outside the submitted work.

Stavrakis AI, Khoshbin A, and Parks ML declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors

Additional information

This article is part of the Topical Collection on Surgery and Perioperative Care

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Stavrakis, A.I., Khoshbin, A., McLawhorn, A.S. et al. Bariatric Surgery Prior to Total Joint Arthroplasty, Does it Decrease the Risk of Obesity Related Perioperative Complications?. Curr Rheumatol Rep 20, 7 (2018). https://doi.org/10.1007/s11926-018-0717-5

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11926-018-0717-5

Keywords

Navigation