Aims

The purpose of this study was to determine the association between prior sleeve gastrectomy in patients undergoing primary total hip and knee arthroplasty, and 90-day complications, incidence of revision arthroplasty, and patient-reported outcome scores at final follow-up.

The August 2024 Knee Roundup. 360. looks at: Calcification’s role in knee osteoarthritis: implications for surgical decision-making; Lower complication rates and shorter lengths of hospital stay with technology-assisted total knee arthroplasty; Revision surgery: the hidden burden on surgeons; Are preoperative weight loss interventions worthwhile?; Total knee arthroplasty with or without prior bariatric surgery: a systematic review and meta-analysis; Aspirin triumphs in knee arthroplasty: a decade of evidence; Efficacy of DAIR in unicompartmental knee arthroplasty: a glimpse from Oxford

C.D. Watts, J.R. Martin, M. T. Houdek, M. P. Abdel, D. G.Lewallen, M. J. Taunton Prior bariatric surgery may decrease the rate of reoperation and revision following total hip arthroplasty. Bone Joint J 2016;98-B:1180–1184

Aims. We compared the outcome of total hip arthroplasty (THA) in obese patients who previously underwent bariatric surgery and those who did not, in a matched cohort study. Patients and Methods. There were 47 THAs in the bariatric group (42 patients), and 94 THAs in the comparison group (92 patients). The mean age of the patients was 57 years in both groups (24 to 79) and 57% of the patients in both groups were women. The mean time between bariatric surgery and THA was five years (four months to 12 years) in the bariatric group. The mean follow-up after THA was three years (2 to 9). . Results. The mean BMI improved from 49.7 kg/m. 2. (35 to 75) prior to bariatric surgery to 35.3 kg/m. 2 . (21 to 49) at the time of THA (p < 0.001). Patients in the comparison group had an increased risk of re-operation (Hazard Ratio (HR) 3.2; 95% confidence intervals (CI) 1.3 to 9.5, p = 0.01) and revision (HR 5.4; 95% CI 1.5 to 34.5, p = 0.01) when compared with the bariatric group. Conclusion. Patients had a dramatic improvement in BMI after bariatric surgery and those with prior bariatric surgery had a lower risk of re-operation and revision in the short- and mid-term after a subsequent THA. Larger prospective studies are required before it can be concluded that this extra surgery should be advised in these patients. Cite this article: Bone Joint J 2016;98-B:1180–4

Obesity is a global epidemic of 2.1 billion people and a well known cause of osteoarthritis. Joint replacement in the obese attracts more complications, poorer outcomes and higher revision rates. It is a reversible condition and the fundamental principles of dealing with reversible medical conditions prior to elective total joint replacement should apply to obesity. The dilemma for orthopaedic surgeons is when to offer surgery in the face of a reversible condition, which if treated may obviate joint replacement and reduce the risk and severity of obesity related disease in both the medical arena and the field of orthopaedics.