title: Benefits of bariatric surgery before elective total joint arthroplasty: is there a role for weight loss optimization?
abstract: BACKGROUND
  The association between obesity and osteoarthritis is well established, as is the increased risk of postoperative complications after total knee arthroplasty (TKA) and total hip arthroplasty (THA) among patients with obesity.
  
  
  OBJECTIVE
  To evaluate the outcomes after TKA/THA based on whether the surgery was performed before or after bariatric surgery.
  
  
  METHODS
  Integrated, multispecialty, community teaching hospital.
  
  
  METHODS
  The medical records of all patients who underwent bariatric surgery from 2001 to 2014 were reviewed. Statistical analysis included χ2test and t tests. A P value<.05 was considered significant.
  
  
  RESULTS
  One-hundred and two patients were included; 36 had TKA/THA before their bariatric procedure, 66 underwent TKA/THA after their bariatric procedure. TKAs/THAs were performed at a mean of 4.9±3.2 years before and 4.3±3.3 years after bariatric surgery. Body mass index for those undergoing TKA/THA after bariatric surgery was lower than those with TKA/THA before bariatric surgery (37.6±7.4 versus 43.7±5.7 kg/m2; P<.001). Operative time and length of stay (LOS) were significantly decreased for TKA/THA performed after versus before bariatric surgery: 81.7±33.9 min versus 117±38.1 min; P<.001 and 2.9±0.7 versus 3.8±1.4 d; P<.001, respectively. Early complications and late reinterventions were similar.
  
  
  CONCLUSIONS
  Decreased operative time and LOS were observed among patients who underwent TKA/THA after versus before their bariatric surgery. Patients who underwent TKA/THA after bariatric surgery had lower body mass index before and 1 year after TKA/THA. Postoperative complication rates were similar. Benefits of bariatric surgery and subsequent weight loss should be considered among patients with obesity requiring TKA/THA. Optimal timing of TKA/THA and bariatric surgery has yet to be established.
authors.affiliation: Department of Medical Education, Gundersen Medical Foundation, La Crosse, Wisconsin.
authors.forename: Emanuel E
authors.initials: EE
authors.lastname: Nearing
authors.affiliation: Department of Medical Research, Gundersen Medical Foundation, La Crosse, Wisconsin.
authors.forename: Tyler M
authors.initials: TM
authors.lastname: Santos
authors.affiliation: Department of Orthopedic Surgery, Gundersen Health System, La Crosse, Wisconsin.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Topolski
authors.affiliation: Department of Medical Research, Gundersen Medical Foundation, La Crosse, Wisconsin.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Borgert
authors.affiliation: Department of Medical Research, Gundersen Medical Foundation, La Crosse, Wisconsin.
authors.forename: Kara J
authors.initials: KJ
authors.lastname: Kallies
authors.affiliation: Department of General Surgery, Gundersen Health System, La Crosse, Wisconsin. Electronic address: snkothar@gundersenhealth.org.
authors.forename: Shanu N
authors.initials: SN
authors.lastname: Kothari
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000706:statistics & numerical data*; D019645:Arthroplasty, Replacement, Knee / Q000706:statistics & numerical data*; D050110:Bariatric Surgery / Q000706:statistics & numerical data*; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery; D061646:Operative Time; D015207:Osteoarthritis, Hip / Q000150:complications / Q000601:surgery; D020370:Osteoarthritis, Knee / Q000150:complications / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology; D012086:Reoperation; D012189:Retrospective Studies; D015431:Weight Loss / Q000502:physiology
keywords: Bariatric surgery; Joint arthroplasty; Obesity; Postoperative outcomes; osteoarthritis