Do you need hip or knee surgery? You may be safer losing weight first.

American Academy of Orthopedic Surgeons Annual Meeting on March 14 in San Diego. Bariatric surgery performed prior to total hip or knee replacement reduced in-hospital and 90-day postoperative complications and improved patient health. In this study involving over 3,600 patients utilizing a study design to eliminate selection bias, obese patients who had bariatric surgery first 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. As ScienceDaily reports, obesity is associated with poor postoperative outcomes after total knee arthroplasty (TKA) and total hip arthroplasty (THA), including increased risk for revision surgery, postoperative infection, and medical complications. Previous studies have shown that bariatric surgery can reduce weight and comorbidities, but clinicians have not known whether the surgery is helpful to patients undergoing a joint replacement. “This study demonstrates that bariatric surgery performed before joint replacement surgery reduces risk and significantly lowers the complication rate for patients,” says Kent Sasse, MD, a Fellow of the American Society of Metabolic and Bariatric Surgery and Director of the nationally Accredited Center for Bariatrics in northern Nevada. Previously some clinicians worried that the surgery might somehow have a negative impact on total joint replacement, while others believed it might improve outcomes by reducing weight and thus the load on a hip or knee joint. To determine the answer, researchers at Hospital for Special Surgery examined the New York Statewide Planning and Research Cooperative System (SPARCS) database, a comprehensive reporting system. They identified all patients who had a THA or TKA in New York State between 1997 and 2011. There were 2,636 patients with BMI>40 who underwent a total knee replacement and 792 who underwent a total hip replacement after bariatric surgery. The researchers then used propensity score matching to build control groups of 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% vs. 5.3%; P<0.0001) and for total knee replacement (2.7% vs. 3.9%; P=0.021). 90-day postoperative complications were also significantly reduced. The researchers say a prospective trial examining the impact of bariatric surgery on a TKA in morbidly obese patients is in the works. Dr. Sasse adds, “With the experience I have gained over the past 17 years, today we offer a dramatic reduction in weight, and a significant reduction in risk to the patient who needs a joint replacement. The laparoscopic sleeve is today a less invasive 45-minute procedure that’s taken the best elements from the more than 5,000 bariatric procedures I have performed over my career. It is safer, simpler, and highly effective. The patient who goes on to have knee or hip surgery has reduced risks of complications like infection or pulmonary embolus, and they have a greater return to mobility. Importantly, we also expect the new joint to have greater durability.”]]>