title: Obesity and the role of bariatric surgery in the surgical management of osteoarthritis of the hip and knee: a review of the literature.
abstract: Obesity accelerates the development of osteoarthritis of the knee and hip by exerting deleterious effects on joints through both biomechanical and also systemic inflammatory changes. The objective of this review was to evaluate the impact of obesity on lower limb biomechanics and total joint arthroplasty outcomes, as well as weight changes after joint arthroplasty and the role of bariatric surgery among patients requiring joint arthroplasty. The currently published data indicate that weight loss increases swing time, stride length, gait speed, and lower extremity range of motion. Total joint arthroplasty improves pain and joint function, but does not induce significant weight loss in the majority of patients. Bariatric surgery improves gait biomechanics, and in the severely obese patient with osteoarthritis improves pain and joint function. The evidence for supporting bariatric surgery before total joint arthroplasty is limited to retrospective reports with conflicting results. Fundamental clinical questions remain regarding the optimal management of morbid obesity and lower extremity arthritis, which should be the focus of future collaborations across disciplines providing care to patients with both conditions.
authors.affiliation: OrthoCarolina Hip and Knee Center, Charlotte NC.
authors.forename: Bryan D
authors.initials: BD
authors.lastname: Springer
authors.affiliation: Department of Surgery, University of California-San Francisco, San Francisco, CA.
authors.forename: Jonathan T
authors.initials: JT
authors.lastname: Carter
authors.affiliation: Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY.
authors.forename: Alexander S
authors.initials: AS
authors.lastname: McLawhorn
authors.affiliation: Metabolic & Bariatric Surgery, Loma Linda University Health, Loma Linda, CA.
authors.forename: Keith
authors.initials: K
authors.lastname: Scharf
authors.affiliation: Department of Surgery, Lenox Hill Hospital, New York, NY.
authors.forename: Mitchell
authors.initials: M
authors.lastname: Roslin
authors.affiliation: Department of Surgery, Gundersen Health System, La Crosse, WI.
authors.forename: Kara J
authors.initials: KJ
authors.lastname: Kallies
authors.affiliation: Department of Surgery, Stanford University, Stanford, CA.
authors.forename: John M
authors.initials: JM
authors.lastname: Morton
authors.affiliation: Department of Surgery, Gundersen Health System, La Crosse, WI. Electronic address: snkothar@gundersenhealth.org.
authors.forename: Shanu N
authors.initials: SN
authors.lastname: Kothari
mesh_terms: D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D050110:Bariatric Surgery; D001696:Biomechanical Phenomena; D006621:Hip Joint / Q000502:physiology; D006801:Humans; D007719:Knee Joint / Q000502:physiology; D009767:Obesity, Morbid / Q000601:surgery*; D015207:Osteoarthritis, Hip / Q000601:surgery*; D020370:Osteoarthritis, Knee / Q000601:surgery*; D011182:Postoperative Care; D011183:Postoperative Complications / Q000209:etiology; D000072799:Stair Climbing / Q000502:physiology; D016896:Treatment Outcome; D016138:Walking / Q000523:psychology
keywords: Bariatric surgery; Hip arthroplasty; Joint arthroplasty; Knee arthroplasty; Lower limb biomechanics; Obesity; Osteoarthritis; Postoperative complications