A Literature Review and Summary Recommendations of the Impact of Bariatric Surgery on Orthopedic Outcomes
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REVIEW
A Literature Review and Summary Recommendations of the Impact of Bariatric Surgery on Orthopedic Outcomes Michel M. Murr 1
&
William J. Streiff 1 & Roger Ndindjock 2
Received: 17 April 2020 / Revised: 11 November 2020 / Accepted: 11 November 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Many surgeons recommend weight loss in preparation for orthopedic procedures, yet the impact of surgically induced weight loss before orthopedic procedures is not clear. We undertook a literature review to assess the impact of bariatric surgery on the outcomes of total joint arthroplasty (TJA). We searched PubMed, Medline, Cochrane Library, and Google Scholar for studies (2010–2017) that evaluated the associations between obesity, bariatric surgery, and orthopedic surgery. Nine studies found that prior bariatric surgery decreased major and minor post-operative complications, operating room (OR) time, length of stay (LOS), risk of re-operation, and 90day re-admissions after TJA. Two studies found that bariatric surgery patients had a higher reoperation rate for stiffness and infection as well as need for revision within 90 days after TJA. One meta-analysis found no statistically significant differences in wound infections, revisions, or mortality irrespective of bariatric surgery status; and another meta-analysis showed reduced medical complications, LOS, and OR time. Our review highlights many gaps in our knowledge and the need for additional studies to define the impact of the bariatric-first approach on TJA outcomes. We propose a framework from lessons learned to raise awareness of medical and surgical options of weight management before elective orthopedic operations in patients with obesity. Keywords Guidelines . Degenerative joint disease . Osteoarthritis . Mobility . Outcomes . Complications . Bone health . Orthopedics . Artificial joints . Prosthesis
Background Obesity is a major risk factor for osteoarthritis [1] and is associated with worse outcomes of total knee arthroplasty (TKA) [2] and total hip arthroplasty (THA) [3]. The risk of wound infection [4], deep vein thrombosis (DVT) [5], readmissions [6], complications [7], and prosthetic joint infection [8] are significantly increased in patients with obesity undergoing total joint arthroplasty (TJA). The Association of Hip and Knee Surgeons recommends weight loss for patients with a BMI ≥ 40 prior to TJA [9]. Because of the limited success of caloric restriction and the impracticality of exercise in patients with osteoarthritis, bariatric surgery is being considered as a bridge to TJA. The purpose * Michel M. Murr [email protected] 1
AdventHealth Tampa, Bariatric and Metabolic Surgery Institute, 3000 Medical Park Drive, Suite 490, Tampa, FL 33613, USA
2
Medtronic-Surgical Innovations, Health Economics, Policy and Reimbursement, 710 Medtronic Parkway NE, Minneapolis, MN 55432, USA
of this contemporary literature review is to compare outcomes of TJA in patients with obesity who underwent bariatric surgery prior
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