title: Effect of non-surgical, non-pharmacological weight loss interventions in patients who are obese prior to hip and knee arthroplasty surgery: a rapid review.
abstract: BACKGROUND
  Of the more than 104,000 Canadians who underwent elective total joint arthroplasty (TJA) surgery in 2012-2013 for hip and knee osteoarthritis (OA), 40 and 60 %, respectively, were obese. Obesity is associated with increased risks for receiving TJA, post-operative complications and delayed functional recovery. Current guidelines for patients with a body mass index (BMI) of ≥30 kg/m(2) are to participate in a weight management programme and to lose weight prior to TJA surgery. As part of a larger project, a rapid review was conducted to examine the effects of short-term non-pharmacological and non-surgical weight loss interventions in adults in the year prior to total hip arthroplasty (THA) and total knee arthroplasty (TKA) on surgical and patient outcomes, and adverse events.
  
  
  METHODS
  We performed a rapid review and searched seven electronic databases for English language articles published between 1990 and February 2015. Observational studies evaluating the association between pre-operative weight loss and short- and long-term outcomes, and controlled trials of non-pharmacological and non-surgical weight loss interventions were considered for inclusion. Two reviewers independently screened and selected articles, assessed methodological quality and extracted data.
  
  
  RESULTS
  Of 263 articles identified, a total of four studies met our inclusion criteria. In one of two high-quality retrospective cohort studies, weight loss ≥5 % of body weight in the year prior to TJA and maintained in the year after surgery was associated with a higher likelihood of deep surgical site infection in THA patients and 90-day readmission in TKA patients. No significant differences were reported in incidence of superficial surgical site infections in THA or TKA patients who lost weight pre-operatively compared to those who maintained their weight in either study. Two abstracts of randomized controlled trials were included; however, despite contacting the authors, full-length articles were not available. The limited information from the trials suggested that short-term dietician-supervised weight loss interventions were effective in weight loss prior to TJA.
  
  
  CONCLUSIONS
  There is limited evidence to support the recommendation of weight loss in the year prior to TJA and to determine the effectiveness of short-term non-pharmacological, non-surgical weight management interventions on patient and surgical outcomes.
authors.affiliation: Department of Occupational Therapy, Surrey Memorial Hospital, 13750 96 Avenue, Surrey, BC, V3V 1Z2, Canada. Michelle.Lui@alumni.ubc.ca.
authors.forename: Michelle
authors.initials: M
authors.lastname: Lui
authors.affiliation: Department of Physical Therapy, University of Alberta, 8205 114 Street, 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada. cajones@ualberta.ca.
authors.forename: C Allyson
authors.initials: CA
authors.lastname: Jones
authors.affiliation: School of Public Health, University of Alberta, c/o Arthritis Research Canada, 5591 No. 3 Road, Richmond, BC, V6X 2C7, Canada. marie.westby@vch.ca.
authors.forename: Marie D
authors.initials: MD
authors.lastname: Westby
mesh_terms: D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D015992:Body Mass Index; D002170:Canada; D006621:Hip Joint / Q000473:pathology / Q000601:surgery; D006801:Humans; D007719:Knee Joint / Q000473:pathology / Q000601:surgery; D009765:Obesity / Q000150:complications* / Q000628:therapy; D015207:Osteoarthritis, Hip / Q000150:complications* / Q000601:surgery; D020370:Osteoarthritis, Knee / Q000150:complications* / Q000601:surgery; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D015431:Weight Loss