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HSS Journal ®
Published in: HSS Journal ® 2/2019

Open Access 01-07-2019 | Obesity | Review Article

The Effect of Bariatric Surgery Prior to Lower-Extremity Total Joint Arthroplasty: A Systematic Review

Authors: Alex Gu, Jordan S. Cohen, Michael-Alexander Malahias, MD, Danny Lee, Peter K. Sculco, MD, Alexander S. McLawhorn, MD, MBA

Published in: HSS Journal ® | Issue 2/2019

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Abstract

Background

Obesity is an independent risk factor for osteoarthritis and has been associated with increased rate of complications following lower-extremity total joint arthroplasty (TJA). Bariatric surgery (BS) is a surgical option for weight loss and for reducing obesity-related comorbidities in morbidly obese patients.

Purpose/Questions

The goal of this systematic review was to answer the following questions: (1) Does BS prior to TJA correlate with lower post-operative complication rates in morbidly obese patients undergoing TJA? (2) Does BS have an impact on revision rates following TJA?

Methods

Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and checklist, a systematic review of medical databases (PubMed/ MEDLINE, Cochrane Library, Web of Science, and Clinicaltrials.​gov) was undertaken for articles published in English from January 1990 to September 2018. Inclusion criteria were studies that included at least ten patients who underwent BS prior to TJA, collected data on complications or other outcomes, and followed patients for at least 90 days after TJA. A descriptive and critical analysis of the results was performed.

Results

From 799 studies, 13 met inclusion criteria. A total of 11,770 patients who had undergone bariatric surgery prior to TJA were analyzed. The quality of the evidence ranged between moderate and high. There was no consensus on the effect of previous BS on early- to short-term outcomes reported after TJA.

Conclusion

The literature remains conflicted on the impact of BS prior to TJA on early, short-term, and long-term complications after TJA. Additional well-matched, observational studies may further our understanding of the impact of BS prior to TJA on outcomes. In particular the effect of various types of BS prior to TJA on outcomes has yet to be elucidated. Ideally, prospective studies with higher level of evidence will be more definitive on the effects of BS prior to TJA.
Prospero Registration Number: CRD42016043025.
Appendix
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Metadata
Title
The Effect of Bariatric Surgery Prior to Lower-Extremity Total Joint Arthroplasty: A Systematic Review
Authors
Alex Gu
Jordan S. Cohen
Michael-Alexander Malahias, MD
Danny Lee
Peter K. Sculco, MD
Alexander S. McLawhorn, MD, MBA
Publication date
01-07-2019
Publisher
Springer US
Published in
HSS Journal ® / Issue 2/2019
Print ISSN: 1556-3316
Electronic ISSN: 1556-3324
DOI
https://doi.org/10.1007/s11420-019-09674-2

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