Does Bariatric Surgery Prior to Primary Total Knee Arthroplasty Improve Outcomes?

Link: https://doi.org/S0883-5403(22)00199-1
Authors: Ryan, Sean P; Couch, Cory G; Duong, Stephanie Q; Taunton, Michael J; Lewallen, David G; Berry, Daniel J; Abdel, Matthew P

Abstract: Recent advancements in bariatric surgical techniques have increased its utilization for the management of morbid obesity prior to total knee arthroplasty (TKA). We hypothesized that bariatric surgery prior to primary TKA would mitigate postoperative complications and improve implant survivorship. Bariatric patients demonstrated higher revision rates than low (HR 4, P < .01) and high BMI (HR 9, P < .01) controls, and increased reoperations when compared to the low (HR 2, P < .01) and high BMI (HR 6, P < .01) groups. Reoperation for instability was more common in bariatric patients than low (HR 15, P = .01) and high BMI (HR 17, P < .01) groups. Reoperation for infection was higher in bariatric patients relative to the high BMI (HR 6, P = .03), but not the low BMI cohort (HR 3, P = .06). There was no difference in 90-day complications (P = .33). Bariatric patients with high BMI and contemporary bariatric procedures did not significantly impact complications or survivorship, but bariatric surgery >2 years before TKA was associated with higher revision rates (P = .01). This study found that bariatric surgery patients who undergo primary TKA have worse implant survivorship, mostly related to infection and instability. Further investigation into perioperative optimization is warranted. Prognostic Level IV.