The Role of Bariatric Surgery Prior to Total Joint Arthroplasty

For candidates of total joint arthroplasty (TJA), bariatric surgery is often recommended for those who are morbidly obese with end-stage arthroplasty. During a poster presentation at the AAOS 2018 Annual Meeting, researchers from New York University Langone Health presented their study, which looked at the effect of time from bariatric surgery to TJA on 90-day complication and hospital readmission rates.

Using the Healthcare Cost and Utilization Project California State Inpatient Database, they identified 330 cases of bariatric surgery followed by total hip arthroplasty (THA) and 1,017 cases that were followed by total knee arthroplasty (TKA) between 2007 and 2011.

There were no significant demographic differences between patients who underwent TJA at less than or greater than six months after bariatric surgery. Patients undergoing THA more than six months after bariatric surgery were significantly less likely to be readmitted within 90 days for any cause; among patients who underwent TKA, the researchers observed a similar association. There was no association between time from bariatric surgery to THA or TKA for 90-day complications. Female patients were more likely to have complications after THA and TKA compared with males (odds ratio [OR] = 1.82; 95% CI 1.1-3.0 vs. OR=1.56; 95% CI 1.12-2.17).

“Delaying THA at least six months after bariatric surgery may help reduce the rate of 90-day readmissions in this high-risk patient population,” the authors concluded.

Additional research is needed to better evaluate whether the type of bariatric procedure affects timing of treatment response. Arthroplasty surgeons recommending bariatric surgery as part of preoperative risk modification should consider the patient’s overall nutritional status, medical comorbidities, and overall response to surgery prior TJA, the researchers noted.