Association between bariatric surgery and outcomes of total joint arthroplasty: a meta-analysis.

BACKGROUND

Total joint arthroplasty (TJA) alongside bariatric surgery (BS) is frequently operated on in obese arthritis patients. The controversy persists regarding BS before TJA, and the extent of its impact on the prognosis of TJA patients remains uncertain. To explore this, we conducted a meta-analysis.

METHODS

As of 1 October 2023, the latest search on PubMed, Cochrane Library, Embase, and Web of Science was conducted to compare outcomes between patients who underwent preoperative BS and those who did not. The analysis focused on parameters such as length of stay (LOS), infection risk, venous thromboembolism, revision, transfusions, dislocations, periprosthetic fractures, knee stiffness, medical complications, and all-cause mortality in the eligible studies.

RESULTS

This meta-analysis included 18 trials with a total of 292 196 patients. Pooled findings indicated that preoperative BS significantly shortened the LOS (MD, -0.16; 95% CI, -0.25 to 0.07; I2 =58%; P =0.0004) and increased the risk of dislocation within 90 days (OR, 1.70; 95% CI, 1.20- 2 .42; I2 =21%; P =0.003) and all-cause mortality within 30 days (OR, 3.69; 95% CI, 1.81-7.49; I2 = 0%; P  =0.0003) for TJA, in comparison with patients without BS. In the total hip arthroplasty (THA) subgroup, BS was more favorable, exhibiting significantly reduced risk of short-term revision (OR, 0.77; 95% C I , 0.61-0.99; I2 =0%; P =0.04) and long-term infection (OR, 0.72; 95% CI, 0.61-0.85; I2 =0%; P ≤0.0001). For total knee arthroplasty (TKA) patients, no significant benefit was identified. In addition, there was no statistically significant correlation between preoperative or postoperative BS and the occurrence of complications in TJA patients.

CONCLUSIONS AND RELEVANCE

Compared with the control group without BS, preoperative BS can shorten the LOS, increase the risk of dislocation within 90 days and all-cause mortality within 30 days in TJA, and reduce the risk of specific surgical complications in the THA subgroup but shows no significant difference in the TKA subgroup. There are no differences in clinical outcomes whether BS is performed before or after TJA. More high-quality trials are needed to further clarify the impact of BS on obese patients undergoing TJA.