Subscribe to RSS
DOI: 10.1055/s-0044-1781433
The Impact of Bariatric Surgery on Postoperative Complications and Outcomes following Primary Total Hip Arthroplasty
![](https://www.thieme-connect.de/media/10.1055-s-00031934/EFirst/lookinside/thumbnails/10-1055-s-0044-1781433_22apr23oa-1.jpg)
Abstract
The prevalence of obesity is significantly increasing in the U.S. population and is associated with both increased incidence of total hip arthroplasty (THA) and potentially worsened postoperative outcomes. Current guidelines strongly encourage exercise-based weight loss in morbidly obese THA candidates to decrease patient risk profiles, but data on the impact of receiving bariatric surgery (BS) for weight loss prior to THA are limited and controversial. The purpose of this study was to clarify the impact of BS on postoperative complications and outcomes following THA. Using Current Procedural Terminology, International Classification of Diseases (ICD)-9, and ICD-10 codes, patients undergoing primary THA from 2010 to 2018 were retrospectively collected from PearlDiver's Mariner dataset. Patients were divided into three cohorts who underwent primary THA: nonmorbidly obese patients, morbidly obese patients, and morbidly obese patients who underwent THA within 2 years of BS. Patients were subsequently matched based on age, Charlson Comorbidity Index, gender, and tobacco use. The primary outcome of this study was the frequency of 90-day and 2-year postoperative complications following primary THA. Compared with morbidly obese non-BS patients, morbidly obese patients who underwent BS prior to receiving a primary THA were less likely to have blood transfusion (4.24 vs. 7.44%, p < 0.05), cellulitis (2.92 vs. 6.11%, p < 0.05), myocardial infarction (2.39 vs. 4.91%, p < 0.05), and deep venous thrombosis (1.06 vs. 3.05%, p < 0.05) at 90-day follow-up. The remaining 90-day postoperative outcomes were not found to be statistically different between cohorts. There were no significant differences in 2-year surgical complications between the morbidly obese non-BS cohort and morbidly obese BS cohort. In this study, we found that morbidly obese patients who underwent BS prior to THA had fewer 90-day medical complications and no significant differences in 2-year surgical complications compared with those who did not undergo BS prior to THA.
Publication History
Received: 29 April 2022
Accepted: 17 January 2024
Article published online:
05 March 2024
© 2024. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 Pirruccio K, Sloan M, Sheth NP. Trends in obesity prevalence among total hip arthroplasty patients and the effect on surgical outcomes, 2008-2016. J Orthop 2019; 16 (04) 347-352 [published correction appears in J Orthop 2020;24:293]
- 2 Choban PS, Dickerson RN. Morbid obesity and nutrition support: is bigger different?. Nutr Clin Pract 2005; 20 (04) 480-487
- 3 Visser AW, de Mutsert R, le Cessie S, den Heijer M, Rosendaal FR, Kloppenburg M. NEO Study Group. The relative contribution of mechanical stress and systemic processes in different types of osteoarthritis: the NEO study. Ann Rheum Dis 2015; 74 (10) 1842-1847
- 4 Bourne R, Mukhi S, Zhu N, Keresteci M, Marin M. Role of obesity on the risk for total hip or knee arthroplasty. Clin Orthop Relat Res 2007; 465 (465) 185-188
- 5 Haverkamp D, Klinkenbijl MN, Somford MP, Albers GH, van der Vis HM. Obesity in total hip arthroplasty–does it really matter? A meta-analysis. Acta Orthop 2011; 82 (04) 417-422
- 6 Koonce RC, Bravman JT. Obesity and osteoarthritis: more than just wear and tear. J Am Acad Orthop Surg 2013; 21 (03) 161-169
- 7 Tohidi M, Brogly SB, Lajkosz K. et al. Ten-year risk of complication and mortality after total hip arthroplasty in morbidly obese patients: a population study. Can J Surg 2019; 62 (06) 442-449
- 8 Jeschke E, Citak M, Günster C. et al. Obesity increases the risk of postoperative complications and revision rates following primary total hip arthroplasty: an analysis of 131,576 total hip arthroplasty cases. J Arthroplasty 2018; 33 (07) 2287-2292.e1
- 9 Kolasinski SL, Neogi T, Hochberg MC. et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken) 2020; 72 (02) 149-162 [published correction appears in Arthritis Care Res (Hoboken) 2021;73(5):764]
- 10 Phillips BT, Shikora SA. The history of metabolic and bariatric surgery: development of standards for patient safety and efficacy. Metabolism 2018; 79: 97-107
- 11 Ponnusamy KE, Vasarhelyi EM, McCalden RW, Somerville LE, Marsh JD. Cost-effectiveness of total hip arthroplasty versus nonoperative management in normal, overweight, obese, severely obese, morbidly obese, and super obese patients: a Markov model. J Arthroplasty 2018; 33 (12) 3629-3636
- 12 Carroll JD, Young JR, Mori BV, Gheewala R, Lakra A, DiCaprio MR. Total hip and knee arthroplasty surgery in the morbidly obese patient: a critical analysis review. JBJS Rev 2023; 11 (04) e22.00177
- 13 Botros M, Guirguis P, Balkissoon R, Myers TG, Thirukumaran CP, Ricciardi BF. Is morbid obesity a modifiable risk factor in patients who have severe knee osteoarthritis and do not have a formal perioperative optimization program?. J Arthroplasty 2023; S0883-5403 (23)00926-9
- 14 Heuts EAF, de Jong LD, Hazebroek EJ, Wagener M, Somford MP. The influence of bariatric surgery on hip and knee joint pain: a systematic review. Surg Obes Relat Dis 2021; 17 (09) 1637-1653
- 15 Mellion KM, Grover BT. Obesity, bariatric surgery, and hip/knee arthroplasty outcomes. Surg Clin North Am 2021; 101 (02) 295-305
- 16 Li S, Luo X, Sun H, Wang K, Zhang K, Sun X. Does prior bariatric surgery improve outcomes following total joint arthroplasty in the morbidly obese? A meta-analysis. J Arthroplasty 2019; 34 (03) 577-585
- 17 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 (09) 1160-1166
- 18 Liu JX, Paoli AR, Mahure SA, Bosco III J, Campbell KA. Preoperative bariatric surgery utilization is associated with increased 90-day postoperative complication rates after total joint arthroplasty. J Am Acad Orthop Surg 2020; 28 (05) e206-e212
- 19 Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care 1998; 36 (01) 8-27
- 20 Gu A, Malahias MA, Cohen JS. et al. Prior knee arthroscopy is associated with increased risk of revision after total knee arthroplasty. J Arthroplasty 2020; 35 (01) 100-104
- 21 Healy WL, Iorio R, Clair AJ, Pellegrini VD, Della Valle CJ, Berend KR. Complications of total hip arthroplasty: standardized list, definitions, and stratification developed by the hip society. Clin Orthop Relat Res 2016; 474 (02) 357-364
- 22 Courcoulas AP, Christian NJ, Belle SH. et al; Longitudinal Assessment of Bariatric Surgery (LABS) Consortium. Weight change and health outcomes at 3 years after bariatric surgery among individuals with severe obesity. JAMA 2013; 310 (22) 2416-2425
- 23 Colquitt JL, Pickett K, Loveman E, Frampton GK. Surgery for weight loss in adults. Cochrane Database Syst Rev 2014; 2014 (08) CD003641
- 24 Cornejo-Pareja I, Clemente-Postigo M, Tinahones FJ. Metabolic and endocrine consequences of bariatric surgery. Front Endocrinol (Lausanne) 2019; 10: 626
- 25 Sax OC, Chen Z, Bains SS. et al. Timing and type of bariatric surgery preceding total knee arthroplasty leads to similar complications and outcomes. J Arthroplasty 2022; 37 (8S): S842-S848
- 26 Murr MM, Streiff WJ, Ndindjock R. A literature review and summary recommendations of the impact of bariatric surgery on orthopedic outcomes. Obes Surg 2021; 31 (01) 394-400
- 27 Premkumar A, Lebrun DG, Sidharthan S. et al. Bariatric surgery prior to total hip arthroplasty is cost-effective in morbidly obese patients. J Arthroplasty 2020; 35 (07) 1766-1775.e3
- 28 Ryan SP, Couch CG, Duong SQ. et al. Frank Stinchfield award: does bariatric surgery prior to primary total hip arthroplasty really improve outcomes?. J Arthroplasty 2022; 37 (7S): S386-S390
- 29 Seward MW, Chen AF. Obesity, preoperative weight loss, and telemedicine before total joint arthroplasty: a review. Arthroplasty 2022; 4 (01) 2
- 30 Gupta RK, Schwenk ES. Bariatric surgery and total knee/hip arthroplasty: an analysis of the impact of sequence and timing on outcomes: an infographic. Reg Anesth Pain Med 2021; 46 (11) 946
- 31 Hwang SK. Experience of complications of hip arthroplasty. Hip Pelvis 2014; 26 (04) 207-213
- 32 Dowsey MM, Brown WA, Cochrane A, Burton PR, Liew D, Choong PF. Effect of bariatric surgery on risk of complications after total knee arthroplasty: a randomized clinical trial. JAMA Netw Open 2022; 5 (04) e226722
- 33 Maoz G, Phillips M, Bosco J. et al. The Otto Aufranc award: modifiable versus nonmodifiable risk factors for infection after hip arthroplasty. Clin Orthop Relat Res 2015; 473 (02) 453-459
- 34 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
- 35 Wallace G, Judge A, Prieto-Alhambra D, de Vries F, Arden NK, Cooper C. The effect of body mass index on the risk of post-operative complications during the 6 months following total hip replacement or total knee replacement surgery. Osteoarthritis Cartilage 2014; 22 (07) 918-927
- 36 Kinlen D, Cody D, O'Shea D. Complications of obesity. QJM 2018; 111 (07) 437-443
- 37 Johnson CA, White CC, Kunkle BF, Eichinger JK, Friedman RJ. Effects of the obesity epidemic on total hip and knee arthroplasty demographics. J Arthroplasty 2021; 36 (09) 3097-3100
- 38 Mechanick JI, Youdim A, Jones DB. et al; American Association of Clinical Endocrinologists, Obesity Society, American Society for Metabolic & Bariatric Surgery. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient–2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity (Silver Spring) 2013; 21 (01) S1-S27
- 39 Ferguson RJ, Palmer AJ, Taylor A, Porter ML, Malchau H, Glyn-Jones S. Hip replacement. Lancet 2018; 392 (10158): 1662-1671