An analysis of morbidly obese patients who underwent a THA or TKA after having bariatric surgery to lose weight suggests that the bariatric surgery can help reduce postoperative complications and improve patient health.
However, researchers from the Hospital for Special Surgery (HSS), who conducted the analysis, report also that the bariatric surgery does not reduce the risk of needing a revision surgery.
The study was presented at the recent American Academy of Orthopaedic Surgeons Annual Meeting.
“With our data, I think we can say with confidence that bariatric surgery prior to total joint replacement is not a harmful recommendation,” says Alexander McLawhorn, MD, MBA, an assistant attending orthopedic surgeon at Hospital for Special Surgery in New York City and the study’s lead author, in a media release from (HSS).
In their study, the researchers used the New York Statewide Planning and Research Cooperative System (SPARCS) database to identify all morbidly obese patients who had a total hip arthroplasty (THA) or total knee arthroplasty (TKA) in New York State between 1997 and 2011. They identified 2,636 patients who underwent a total knee replacement and 792 who underwent a total hip replacement after bariatric surgery.
Then, using propensity score matching, they built control groups of morbidly obese patients receiving total hips and knees without prior or subsequent bariatric surgery.
Statistical analyses showed that bariatric surgery lowered the comorbidity burden of patients prior to total joint replacement (P<0.0001 for TKA and P<0.005 for THA). Morbidly obese patients who had bariatric surgery had lower rates of in-hospital complications for total hip replacement (1.5% versus 5.3%; P<0.0001) and for total knee replacement (2.7% versus 3.9%; P=0.021), the release explains.
From this data, the researchers state that morbidly obese patients who had bariatric surgery were 75% less likely to have in-hospital complications from a total hip replacement and 31% less likely to have in-hospital complications for a total knee replacement.
The risk for 90-day postoperative complications was also lower in patients who received bariatric surgery, 14% lower in the THA group (odds ratio [OR], 0.86; P=0.041) and 61% lower in the TKA group (OR, 39%; P=0.0019). Bariatric surgery did not lower the risk of having a revision surgery or the risk for a hip dislocation, the release continues.
The research team’s further plans include conducting a prospective trial examining the impact of bariatric surgery on a TKA in morbidly obese patients.
“The question is how do we optimize these patients who have a real problem with their hip or knee and the comorbid condition of obesity, so that they can achieve maximal benefit from their joint replacement,” McLawhorn concludes.
[Source(s): Hospital for Special Surgery, Science Daily]
