1
|
De Luca M, Shikora S, Eisenberg D, Angrisani L, Parmar C, Alqahtani A, Aminian A, Aarts E, Brown W, Cohen RV, Di Lorenzo N, Faria SL, Goodpaster KPS, Haddad A, Herrera M, Rosenthal R, Himpens J, Iossa A, Kermansaravi M, Kow L, Kurian M, Chiappetta S, LaMasters T, Mahawar K, Merola G, Nimeri A, O'Kane M, Papasavas P, Piatto G, Ponce J, Prager G, Pratt JSA, Rogers AM, Salminen P, Steele KE, Suter M, Tolone S, Vitiello A, Zappa M, Kothari SN. Scientific Evidence for the Updated Guidelines on Indications for Metabolic and Bariatric Surgery (IFSO/ASMBS). Obes Surg 2024:10.1007/s11695-024-07370-7. [PMID: 39320627 DOI: 10.1007/s11695-024-07370-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 05/21/2024] [Indexed: 09/26/2024]
Abstract
The 2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) updated the indications for Metabolic and Bariatric Surgery (MBS), replacing the previous guidelines established by the NIH over 30 years ago. The evidence supporting these updated guidelines has been strengthened to assist metabolic and bariatric surgeons, nutritionists, and other members of multidisciplinary teams, as well as patients. This study aims to assess the level of evidence and the strength of recommendations compared to the previously published criteria.
Collapse
Affiliation(s)
| | - Scott Shikora
- Department of Surgery, Center for Metabolic and Bariatric Surgery, Brigham and Women's Hospital , and Harvard Medical School, Boston, MA, USA
| | - Dan Eisenberg
- Department of Surgery, Stanford School of Medicine, VA Palo Alto Health Care System, 3801 Miranda Avenue , GS 112, Palo Alto, CA, 94304, USA
| | - Luigi Angrisani
- Department of Public Health, Federico II University of Naples, Naples, Italy
| | | | - Aayed Alqahtani
- New You Medical Center, King Saud University, Riyadh, Saudi Arabia
| | - Ali Aminian
- Department of General Surgery, Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Edo Aarts
- Weight Works Clinics and Allurion Clinics, Amersfoort, The Netherlands
| | - Wendy Brown
- Department of Surgery, Central Clinical School, Alfred Health, Monash University, Melbourne, Victoria, Australia
| | - Ricardo V Cohen
- Center for the Treatment of Obesity and Diabetes, Hospital Alemão Oswaldo Cruz, São Paolo, Brazil
| | - Nicola Di Lorenzo
- Department of Surgical Sciences, University of Rome "Tor Vergata", Rome, Italy
| | - Silvia L Faria
- Gastrocirurgia de Brasilia, University of Brasilia, Brasilia, Brazil
| | | | - Ashraf Haddad
- Gastrointestinal Bariatric and Metabolic Center (GBMC), Jordan Hospital, Amman, Jordan
| | - Miguel Herrera
- Endocrine and Bariatric Surgery, UNAM at INCMNSZ, Mexico City, Mexico
| | - Raul Rosenthal
- Cleveland Clinic Florida, The Bariatric Institute, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - Jacques Himpens
- Bariatric Surgery Unit, Delta Chirec Hospital, Brussels, Belgium
| | - Angelo Iossa
- Department of Medico Surgical Sciences and Biotechnologies Sapienza Polo Pontino, ICOT Hospital Latina, Latina, Italy
| | - Mohammad Kermansaravi
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Hazrat-e Fatemeh Hospital, Iran University of Medical Sciences, Tehran,, Iran
| | - Lilian Kow
- Adelaide Bariatric Centre, Flinders University of South Australia, Adelaide, Australia
| | - Marina Kurian
- Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Sonja Chiappetta
- Department of General and Laparoscopic Surgery, Obesity and Metabolic Surgery Unit, Ospedale Evangelico Betania, Naples, Italy
| | | | - Kamal Mahawar
- South Tyneside and Sunderland Foundation NHS Trust, Sunderland, UK
| | - Giovanni Merola
- General and Laparoscopic Surgery, San Giovanni di Dio Hospital - Frattamaggiore, Naples, Italy
| | - Abdelrahman Nimeri
- Department of Surgery, Center for Metabolic and Bariatric Surgery, Brigham and Women's Hospital , and Harvard Medical School, Boston, MA, USA
| | - Mary O'Kane
- Department of Nutrition and Dietetics, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Pavlos Papasavas
- Division of Metabolic and Bariatric Surgery, Hartford Hospital, Hartford, CT, USA
| | - Giacomo Piatto
- UOC Chirurgia Generale e d'Urgenza, Ospedale di Montebelluna, Montebelluna, Italy
| | - Jaime Ponce
- Bariatric Surgery Program, CHI Memorial Hospital, Chattanooga, TN, USA
| | | | - Janey S A Pratt
- Department of Surgery, Stanford School of Medicine, VA Palo Alto Health Care System, 3801 Miranda Avenue , GS 112, Palo Alto, CA, 94304, USA
| | - Ann M Rogers
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Paulina Salminen
- Division of Digestive Surgery and Urology, Department of Digestive Surgery, Turku University Hospital, Turku, Finland
| | - Kimberley E Steele
- NIDDK Metabolic and Obesity Research Unit, National Institutes of Health, Bethesda, MD, USA
| | - Michel Suter
- Department of Visceral Surgery, University Hospital, Lausanne, Switzerland
| | | | - Antonio Vitiello
- Department of Advanced Biomedical Sciences, Università Degli Studi Di Napoli "Federico II", Naples, Italy
| | - Marco Zappa
- General Surgery Unit, Asst Fatebenefratelli-Sacco Milan, Milan, Italy
| | - Shanu N Kothari
- Department of Surgery, Prisma Health, University of South Carolina School of Medicine, Greenville, SC, USA
| |
Collapse
|
2
|
Momtaz DA, Pereira DE, Singh A, Gonuguntla R, Mittal MM, Torres B, Lee TM, Dayhim F, Hosseinzadeh P, Bendich I. Prior Bariatric Surgery Is Associated With Improved Total Hip Arthroplasty Outcomes in Patients Who Have Obesity: A National Cohort Study With 6 Years of Follow-Up. J Arthroplasty 2024:S0883-5403(24)00686-7. [PMID: 38969294 DOI: 10.1016/j.arth.2024.06.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 06/23/2024] [Accepted: 06/26/2024] [Indexed: 07/07/2024] Open
Abstract
BACKGROUND Obesity is a risk factor for end-stage hip osteoarthritis. While total hip arthroplasty (THA) is commonly performed to reduce pain and improve function associated with osteoarthritis, obesity has been associated with an increased risk of complications after THA. Although bariatric surgery may also be utilized to reduce weight, the impact of bariatric surgery on THA outcomes remains inadequately understood. METHODS This retrospective cohort analysis utilized multicenter electronic medical record data ranging from 2003 to 2023. Patients who have obesity who underwent THA were stratified based on prior bariatric surgery. The final bariatric cohort comprised 451 patients after propensity score matching. Complication rates and revision risks were compared between cohorts at 6, 24, and 72 months. Additional analysis stratified patients by interval between bariatric surgery and THA. RESULTS At 6-month follow-up, the bariatric cohort had significantly lower risks of surgical site infection, wound dehiscence, and deep vein thrombosis (DVT). At 24 months, the bariatric cohort had a lower risk of DVT. At 72-month follow-up, the bariatric cohort had reduced rates of revision, mortality, cardiac morbidity, and Clavien-Dindo grade IV complications. CONCLUSIONS Obese patients who underwent bariatric surgery prior to THA experienced reduced medical complications at all time points and reduced rates of revision at 72 months relative to a matched cohort who did not undergo bariatric surgery.
Collapse
Affiliation(s)
- David A Momtaz
- Department of Orthopaedics, UT Health San Antonio, San Antonio, Texas
| | - Daniel E Pereira
- Department of Orthopaedics, Washington University School of Medicine, St. Louis, Missouri
| | - Aaron Singh
- Department of Orthopaedics, UT Health San Antonio, San Antonio, Texas
| | - Rishi Gonuguntla
- Department of Orthopaedics, UT Health San Antonio, San Antonio, Texas
| | | | - Beltran Torres
- Department of Orthopaedics, Washington University School of Medicine, St. Louis, Missouri
| | | | - Fariba Dayhim
- SSM Health Good Samaritan Hospital, Mt Vernon, Illinois
| | - Pooya Hosseinzadeh
- Department of Orthopaedics, Washington University School of Medicine, St. Louis, Missouri
| | - Ilya Bendich
- Department of Orthopaedics, Washington University School of Medicine, St. Louis, Missouri
| |
Collapse
|
3
|
Hameed D, Bains SS, Dubin JA, Shul C, Chen Z, Stein A, Nace J, Mont MA. Timing Matters: Optimizing the Timeframe for Preoperative Weight Loss to Mitigate Postoperative Infection Risks in Total Knee Arthroplasty. J Arthroplasty 2024; 39:1419-1423.e1. [PMID: 38135167 DOI: 10.1016/j.arth.2023.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 11/21/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND We explore the incidence of periprosthetic infections post-total knee arthroplasty (TKA) in morbidly obese patients who achieved weight loss. Current American Academy of Orthopaedic Surgeons guidelines suggest a preoperative body mass index (BMI) below 40 for TKA. This study assesses infection risks in patients initially who had a BMI of 40-50 who reduced their BMI to under 35 at varying intervals prior to surgery. METHODS We reviewed a national, all-payer database, PearlDiver, for patients undergoing primary TKA. Patients were stratified based on initial BMI of 40 to 50 and reduction of BMI to less than 35 at 3 months (n = 1,932), 3 to 6 months (n = 794), 6 to 9 months (n = 2,233), and 9 to 12 months (n = 1,194) prior to TKA, as well as patients who had a BMI between 40 to 50 (n = 41,632) on the day of surgery. The nonobese group comprised of patients who had a BMI between 20 and 30 (n = 33,294). Multivariate analyses were performed at one-year follow-up. RESULTS We found an increased risk of PJI for patients who had achieved BMI reduction less than nine months prior to TKA, compared to the BMI 20 to 30 cohort at the one-year follow-up (P < .001). Patients who achieved BMI reduction nine to twelve months prior to TKA showed no significant difference in PJI risk compared to the matching nonobese cohort at one-year follow-up (P = .400). CONCLUSIONS In conclusion, our results suggest that weight loss should be achieved at least nine months before TKA to decrease infection risks. These findings have significant implications for surgical considerations in obese patients undergoing TKA.
Collapse
Affiliation(s)
- Daniel Hameed
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Sandeep S Bains
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Jeremy A Dubin
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Craig Shul
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Zhongming Chen
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Alexandra Stein
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - James Nace
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Michael A Mont
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| |
Collapse
|
4
|
de Ree RH, de Jong LD, Hazebroek EJ, Somford MP. Optimal timing of hip and knee arthroplasty after bariatric surgery: A systematic review. J Clin Orthop Trauma 2024; 52:102423. [PMID: 38766387 PMCID: PMC11096744 DOI: 10.1016/j.jcot.2024.102423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 03/18/2024] [Accepted: 04/23/2024] [Indexed: 05/22/2024] Open
Abstract
Background Obesity is a risk factor for the development of osteoarthritis and contributes to the increasing demand for total joint arthroplasty (TJA). Because a lower preoperative weight decreases the risk of complications after TJA, and because bariatric surgery (BS) can reduce weight and comorbidity burden, orthopedic surgeons often recommend BS prior to TJA in patients with obesity. However, the optimal timing of TJA after BS in terms of complications, revisions and dislocations is unknown. Methods PubMed, Embase and Cochrane CENTRAL databases were systematically searched for any type of study reporting rates of complications, revisions and dislocations in patients who had TJA after BS. The included studies' quality was assessed using the Newcastle-Ottawa Scale. Results Out of the 16 studies eligible for review, eight registry-based retrospective studies of high to moderate quality compared different time periods between BS and TJA and overall their results suggest little differences in complication rates. The remaining eight retrospective studies evaluated only one time period and had moderate to poor quality. Overall, there were no clear differences in outcomes after TJA for the different time frames between BS and TJA. Conclusion The results of this systematic review suggest that there is limited and insufficient high-quality evidence to determine the optimal timing of TJA after BS in terms of the rates of complications, revisions and dislocations. Given this lack of evidence, timing of TJA after BS will have to be decided by weighing the individual patients' risk factors against the expected benefits of TJA.
Collapse
Affiliation(s)
- Roy H.G.M. de Ree
- Department of Orthopaedics, Rijnstate Hospital, Wagnerlaan 55, 6815, AD, Arnhem, the Netherlands
| | - Lex D. de Jong
- Department of Orthopaedics, Rijnstate Hospital, Wagnerlaan 55, 6815, AD, Arnhem, the Netherlands
| | - Eric J. Hazebroek
- Department of Bariatric Surgery, Rijnstate Hospital, Wagnerlaan 55, 6815, AD, Arnhem, the Netherlands
| | - Matthijs P. Somford
- Department of Orthopaedics, Rijnstate Hospital, Wagnerlaan 55, 6815, AD, Arnhem, the Netherlands
| |
Collapse
|
5
|
Chan PYW, Mika AP, Martin JR, Wilson JM. Glucagon-like Peptide-1 Agonists: What the Orthopaedic Surgeon Needs to Know. JBJS Rev 2024; 12:01874474-202401000-00003. [PMID: 38181103 DOI: 10.2106/jbjs.rvw.23.00167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2024]
Abstract
» Orthopaedic surgeons are increasingly likely to encounter patients with obesity and/or type 2 diabetes taking glucagon-like peptide-1 (GLP-1) agonists for weight loss.» GLP-1 agonists are an effective treatment for weight loss with semaglutide and tirzepatide being the most effective agents. Randomized controlled trials using these agents have reported weight loss up to 21 kg (46 lb).» The use of GLP-1 agonists preoperatively can improve glycemic control, which can potentially reduce the risk of postoperative complications. However, multiple cases of intraoperative aspiration/regurgitation have been reported, potentially related to the effect of GLP-1 agonists on gastric emptying.» While efficacious, GLP-1 agonists may not produce sufficient weight loss to achieve body mass index cutoffs for total joint arthroplasty depending on individual patient factors, including starting bodyweight. Multifactorial approaches to weight loss with focus on lifestyle modification in addition to GLP-1 agonists should be considered in such patients.» Although GLP-1 agonists are efficacious agents for weight loss, they may not be accessible or affordable for all patients. Each patient's unique circumstances should be considered when creating an ideal weight loss plan during optimization efforts.
Collapse
Affiliation(s)
- Peter Y W Chan
- Department of Orthopaedics, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | | |
Collapse
|
6
|
Bains SS, Sax OC, Chen Z, Nabet A, Nace J, Delanois RE. Bariatric surgery prior to total hip arthroplasty: does timing or type matter? Hip Int 2023; 33:1017-1025. [PMID: 36396616 DOI: 10.1177/11207000221136001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Morbid obesity is a known risk-factor for increased complications following total hip arthroplasty (THA). Thus, many orthopaedic surgeons recommend bariatric surgery (BS). However, there is no consensus on the type (commonly either a Roux-en-Y gastric bypass [RYGB] or sleeve gastrectomy [SG]) and timing of BS prior to THA. Therefore, the purpose of this study is to compare BS recipients prior to THA to assess differences in 90-day to 2-year medical/surgical complications as well as revisions for: (1) type of BS (RYGB and SG); and (2) timing of BS. Additionally, we aim to assess risk factors for postoperative prosthetic joint infections (PJIs), dislocations, and revisions. METHODS We queried a national, all-payer database to identify patients undergoing primary THA from January 2010 to October 2020 (n = 715,100). Patients were then divided into 6 cohorts: 2 cohorts without history of BS (body mass index [BMI] kg/m2 20-35 [n = 59,995]) and BMI > 40 [n = 36,799]); 2 cohorts with previous RYGB (n = 1278) or SG (n = 1051); and 2 cohorts that underwent BS either 6-12 months (n = 412) and >12 months (n = 1655) prior to the THA. Bivariate chi-square analyses of medical and surgical outcomes at 90 days-2 years were conducted. Multivariate logistic regressions identified independent risk factors for PJIs, dislocations, and revisions. RESULTS At 90 days-2 years, no differences in postoperative medical/surgical complications or revisions were seen among timing or type of BS. The BMI > 40 kg/m2 cohort had the highest complication profile among all other cohorts. Timing and type of BS has similar odds of PJIs, dislocations, and revisions. CONCLUSIONS Patients undergoing RYGB or SG 6-12 months and >1 year prior to THA showed similar complications profiles. These results suggest, bariatric patients do not need to wait 1 year before undergoing a THA.
Collapse
Affiliation(s)
- Sandeep S Bains
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Oliver C Sax
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Zhongming Chen
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Austin Nabet
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - James Nace
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Ronald E Delanois
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| |
Collapse
|
7
|
Blankstein M, Browne JA, Sonn KA, Ashkenazi I, Schwarzkopf R. Go Big or Go Home: Obesity and Total Joint Arthroplasty. J Arthroplasty 2023; 38:1928-1937. [PMID: 37451512 DOI: 10.1016/j.arth.2023.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 06/17/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023] Open
Abstract
Obesity is highly prevalent, and it is expected to grow considerably in the United States. The association between obesity and an increased risk of complications following total joint arthroplasty (TJA) is widely accepted. Many believe that patients with body mass index (BMI) >40 have complications rates that may outweigh the benefits of surgery and should consider delaying it. However, the current literature on obesity and outcomes following TJA is observational, very heterogeneous, and full of confounding variables. BMI in isolation has several flaws and recent literature suggests shifting from an exclusively BMI <40 cutoff to considering 5 to 10% preoperative weight loss. BMI cutoffs to TJA may also restrict access to care to our most vulnerable, marginalized populations. Moreover, only roughly 20% of patients instructed to lose weight for surgery are successful and the practice of demanding mandatory weight loss needs to be reconsidered until convincing evidence exists that supports risk reduction as a result of preoperative weight loss. Obese patients can benefit greatly from this life-changing procedure. When addressing the potential difficulties and by optimizing preoperative assessment and intraoperative management, the surgery can be conducted safely. A multidisciplinary patient-centered approach with patient engagement, shared decision-making, and informed consent is recommended.
Collapse
Affiliation(s)
- Michael Blankstein
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, VT, USA
| | - James A Browne
- Department of Orthopedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kevin A Sonn
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Itay Ashkenazi
- Department of Orthopaedic Surgery, NYU Langone Health, New York, New York, USA
| | - Ran Schwarzkopf
- Department of Orthopaedic Surgery, NYU Langone Health, New York, New York, USA
| |
Collapse
|
8
|
Chen Z, Sax OC, Bains SS, Salib CG, Paulson AE, Verma A, Nace J, Delanois RE. Super-obese patients are associated with significant infection burden after total hip arthroplasty. Hip Int 2023; 33:806-811. [PMID: 36703261 DOI: 10.1177/11207000221144740] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Over ⅓ of the population in the United State is obese (body mass index [BMI] >30 kg/m2), with an increasing proportion being morbidly obese (BMI >40 kg/m2). As the obesity rate climbs, an increasing number have entered the super-obese category (BMI >50 kg/m2), theoretically increasing risk for complications after total hip arthroplasty (THA). This study compared complications in non-obese, obese, morbidly obese, and super-obese patients undergoing THA. We specifically assessed: (1) 1- and 2-year peri-prosthetic joint infection (PJI) rates; (2) complication rates; as well as (3) 1- and 2-year revision rates. METHODS A database review identified patients undergoing primary THA from 01 January 2010 to 31 December 2019. Patients were stratified based on the presence of International Classification of Diseases, 9th and 10th revision diagnosis codes of non-obese (BMI <30 kg/m2) (n = 8680), obese (BMI <40 kg/m2) (n = 12,443), morbidly obese (BMI <50 kg/m2) (n = 5250), and super-obese (BMI >50 kg/m2) (n = 814) prior to THA. Complication rates at 90 days, 1 year, and 2 years were compared across groups. RESULTS At all time points, super-obese patients were associated with higher rates of PJI, even when compared to morbidly obese patients. Complications such as sepsis, venous thrombo-embolism, and revision surgeries were found in higher numbers in super-obese as well as morbidly obese patients, compared to obese and non-obese patients. CONCLUSIONS This study provides large-scale analyses demonstrating the association between super-obese and morbidly obese patients and higher infection rates, as well as complications, following THA. Importantly, the association of PJI is highest among super-obese patients, even when compared to morbidly obese patients. Attaining a BMI <40 kg/m2 prior to surgery may be an important goal discussed with patients to lower the chance of postoperative infections.
Collapse
Affiliation(s)
- Zhongming Chen
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Oliver C Sax
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Sandeep S Bains
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Christopher G Salib
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Ambika E Paulson
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Ankush Verma
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - James Nace
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Ronald E Delanois
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| |
Collapse
|
9
|
Jolissaint JE, Kammire MS, Averkamp BJ, Springer BD. An Update on the Management and Optimization of the Patient with Morbid Obesity Undergoing Hip or Knee Arthroplasty. Orthop Clin North Am 2023; 54:251-257. [PMID: 37271553 DOI: 10.1016/j.ocl.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The prevalence of obesity in the United States is at a record high of 42%. In 1999, the Centers for Disease Control and Prevention recognized the obesity epidemic as a national problem, spurring the first generation of interventions for obesity prevention and control. Despite billions of dollars in funding, legislative changes, and public health initiatives, the trajectory of American obesity has not waivered. Obesity is also strongly associated with the development of osteoarthritis. The growing population of young, obese, and sick patients presents a unique dilemma for orthopedic surgeons performing joint replacement, as obesity levels and the demand for joint replacement are only expected to rise further.
Collapse
Affiliation(s)
- Josef E Jolissaint
- Ortho Carolina Hip and Knee Center, Charlotte, NC, USA; Atrium Health - Musculoskeletal Institute, Charlotte, NC, USA
| | - Maria S Kammire
- Ortho Carolina Hip and Knee Center, Charlotte, NC, USA; Atrium Health - Musculoskeletal Institute, Charlotte, NC, USA
| | - Benjamin J Averkamp
- Ortho Carolina Hip and Knee Center, Charlotte, NC, USA; Atrium Health - Musculoskeletal Institute, Charlotte, NC, USA
| | - Bryan D Springer
- Ortho Carolina Hip and Knee Center, Charlotte, NC, USA; Atrium Health - Musculoskeletal Institute, Charlotte, NC, USA.
| |
Collapse
|
10
|
Carroll JD, Young JR, Mori BV, Gheewala R, Lakra A, DiCaprio MR. Total Hip and Knee Arthroplasty Surgery in the Morbidly Obese Patient: A Critical Analysis Review. JBJS Rev 2023; 11:01874474-202304000-00007. [PMID: 37098128 DOI: 10.2106/jbjs.rvw.22.00177] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
» Obesity, defined as body mass index (BMI) ≥30, is a serious public health concern associated with an increased incidence of stroke, diabetes, mental illness, and cardiovascular disease resulting in numerous preventable deaths yearly. » From 1999 through 2018, the age-adjusted prevalence of morbid obesity (BMI ≥40) in US adults aged 20 years and older has risen steadily from 4.7% to 9.2%, with other estimates showing that most of the patients undergoing hip and knee replacement by 2029 will be obese (BMI ≥30) or morbidly obese (BMI ≥40). » In patients undergoing total joint arthroplasty (TJA), morbid obesity (BMI ≥40) is associated with an increased risk of perioperative complications, including prosthetic joint infection and mechanical failure necessitating aseptic revision. » The current literature on the role that bariatric weight loss surgery before TJA has on improving surgical outcomes is split and referral to a bariatric surgeon should be a shared-decision between patient and surgeon on a case-by-case basis. » Despite the increased risk profile of TJA in the morbidly obese cohort, these patients consistently show improvement in pain and physical function postoperatively that should be considered when deciding for or against surgery.
Collapse
Affiliation(s)
- Jeremy D Carroll
- Division of Orthopaedic Surgery, Albany Medical Center, Albany, New York
| | | | | | | | | | | |
Collapse
|
11
|
Ortiz D, Sicat CS, Goltz DE, Seyler TM, Schwarzkopf R. Validation of a Predictive Tool for Discharge to Rehabilitation or a Skilled Nursing Facility After TJA. J Bone Joint Surg Am 2022; 104:1579-1585. [PMID: 35861346 DOI: 10.2106/jbjs.21.00955] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Cost excess in bundled payment models for total joint arthroplasty (TJA) is driven by discharge to rehabilitation or a skilled nursing facility (SNF). A recently published preoperative risk prediction tool showed very good internal accuracy in stratifying patients on the basis of likelihood of discharge to an SNF or rehabilitation. The purpose of the present study was to test the accuracy of this predictive tool through external validation with use of a large cohort from an outside institution. METHODS A total of 20,294 primary unilateral total hip (48%) and knee (52%) arthroplasty cases at a tertiary health system were extracted from the institutional electronic medical record. Discharge location and the 9 preoperative variables required by the predictive model were collected. All cases were run through the model to generate risk scores for those patients, which were compared with the actual discharge locations to evaluate the cutoff originally proposed in the derivation paper. The proportion of correct classifications at this threshold was evaluated, as well as the sensitivity, specificity, positive and negative predictive values, number needed to screen, and area under the receiver operating characteristic curve (AUC), in order to determine the predictive accuracy of the model. RESULTS A total of 3,147 (15.5%) of the patients who underwent primary, unilateral total hip or knee arthroplasty were discharged to rehabilitation or an SNF. Despite considerable differences between the present and original model derivation cohorts, predicted scores demonstrated very good accuracy (AUC, 0.734; 95% confidence interval, 0.725 to 0.744). The threshold simultaneously maximizing sensitivity and specificity was 0.1745 (sensitivity, 0.672; specificity, 0.679), essentially identical to the proposed cutoff of the original paper (0.178). The proportion of correct classifications was 0.679. Positive and negative predictive values (0.277 and 0.919, respectively) were substantially better than those of random selection based only on event prevalence (0.155 and 0.845), and the number needed to screen was 3.6 (random selection, 6.4). CONCLUSIONS A previously published online predictive tool for discharge to rehabilitation or an SNF performed well under external validation, demonstrating a positive predictive value 79% higher and number needed to screen 56% lower than simple random selection. This tool consists of exclusively preoperative parameters that are easily collected. Based on a successful external validation, this tool merits consideration for clinical implementation because of its value for patient counseling, preoperative optimization, and discharge planning. LEVEL OF EVIDENCE Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Dionisio Ortiz
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
| | | | - Daniel E Goltz
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Thorsten M Seyler
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
| |
Collapse
|
12
|
Timing and Type of Bariatric Surgery Preceding Total Knee Arthroplasty Leads to Similar Complications and Outcomes. J Arthroplasty 2022; 37:S842-S848. [PMID: 35121092 DOI: 10.1016/j.arth.2022.01.076] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/10/2022] [Accepted: 01/24/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND No consensus exists regarding the appropriate timing of bariatric surgery (BS) or the complication profiles between Roux-en-Y Gastric Bypass (RYGB) and sleeve gastrectomy (SG) prior to total knee arthroplasty (TKA). We sought to compare 90-day medical and up to two-year surgical complications and revisions among (1) BS performed 6 months and 1 year prior to TKA; (2) between BS types (RYGB and SG) prior to TKA; and (3) with comparison to 2 non-BS cohorts of morbidly and nonmorbidly obese patients. METHODS We queried a national database to identify patients undergoing BS (RYGB and SG) prior to TKA from 2010 to 2020. Timing (six-month and one-year intervals) and type of BS (RYGB and SG) were identified. Cohorts without prior BS served as comparators: BMI, kg/m2 > 40 and 20-35. Ninety-day to two-year medical/surgical complications and revisions were assessed. Multivariate regression analyses examined the risk factors for prosthetic joint infections (PJIs) and revisions. RESULTS The timing of BS (6 months and 1 year) had similar incidences of medical/surgical complications and revisions, with both lower than the BMI > 40 cohort (P < .001). Differences between types of BS were also lower than the BMI > 40 cohort (P < .001). The BMI 20-35 had lower complications and revisions among all cohorts. No differences were observed between BS timing or type as risk-factors for PJIs and revisions. CONCLUSION Timing (6 months or 1 year prior to TKA) and type of BS shared similar complication profiles, lower than BMI > 40 and higher than BMI 20-35. These findings support a surgeon's decision to proceed with TKA at six months post-BS if indicated.
Collapse
|
13
|
Yan M, Zheng G, Long Z, Pan Q, Wang X, Li Y, Lei C. Does bariatric surgery really benefit patients before total knee arthroplasty? A systematic review and meta-analysis. Int J Surg 2022; 104:106778. [PMID: 35870757 DOI: 10.1016/j.ijsu.2022.106778] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 06/29/2022] [Accepted: 07/07/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE At present, whether bariatric surgery before total knee arthroplasty (TKA) affects the prognosis of subsequent TKA has been a topic of debate in the academic community. The primary purpose of this systematic review and meta-analysis was to investigate the effect of previous bariatric surgery on prosthetic revisions and postoperative complications after TKA. METHODS We included prospective and observational studies published in English involving patients who had undergone bariatric surgery prior to TKA and compared them with morbidly obese patients with no history of bariatric surgery. The Newcastle-Ottawa Scale was used to assess the methodological quality of non-randomized case-control studies. The outcomes included revisions, infections, venous thromboembolism (VTE), blood transfusion, mortality, stiffness or manipulation under anesthesia (MUA), and medical complications. RESULTS Of the 9 included studies with 166047 patients, 4 were matched cohort studies, 2 were unmatched cohort, and 3 were database studies. Methodological quality was high in ten studies and moderate in thirteen studies. Our analysis demonstrated that patients with TKA who had undergone prior bariatric surgery were associated with increased risks of long-term revision, long-term infection, long-term stiffness or MUA and blood transfusions, whereas prior bariatric surgery did not increase the risk of short-term complications and short-term revision. CONCLUSION This meta-analysis highlights the risks of bariatric surgery prior to TKA and suggests that prior bariatric surgery may increase the risk of perioperative blood transfusion and also the risk of revision and infection in long-term follow-up. Surgeons can use this information to help counsel patients undergoing bariatric surgery before primary TKA.
Collapse
Affiliation(s)
- Manli Yan
- Department of General Surgery, The Second Affiliated Hospital of Jianghan University (The Fifth Hospital of Wuhan), Wuhan, Hubei, 430050, China
| | - Gang Zheng
- Department of General Surgery, The Second Affiliated Hospital of Jianghan University (The Fifth Hospital of Wuhan), Wuhan, Hubei, 430050, China
| | - Zhixiong Long
- Department of Oncology, The Second Affiliated Hospital of Jianghan University (The Fifth Hospital of Wuhan), Wuhan, Hubei, 430050, China
| | - Qingyun Pan
- Department of Endocrinology, The Second Affiliated Hospital of Jianghan University (The Fifth Hospital of Wuhan), Wuhan, Hubei, 430050, China
| | - Xiaohui Wang
- Department of Nephrology, The Second Affiliated Hospital of Jianghan University (The Fifth Hospital of Wuhan), Wuhan, Hubei, 430050, China
| | - Yuan Li
- Department of General Surgery, The Second Affiliated Hospital of Jianghan University (The Fifth Hospital of Wuhan), Wuhan, Hubei, 430050, China
| | - Changjiang Lei
- Department of General Surgery, The Second Affiliated Hospital of Jianghan University (The Fifth Hospital of Wuhan), Wuhan, Hubei, 430050, China.
| |
Collapse
|
14
|
Ryan SP, Couch CG, Duong SQ, Taunton MJ, Lewallen DG, Berry DJ, Abdel MP. Frank Stinchfield Award: Does Bariatric Surgery Prior to Primary Total Hip Arthroplasty Really Improve Outcomes? J Arthroplasty 2022; 37:S386-S390. [PMID: 35241319 DOI: 10.1016/j.arth.2022.01.084] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/21/2022] [Accepted: 01/27/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Optimal management of morbid obesity before total hip arthroplasty (THA) remains debated. Recently, bariatric procedures have become more common with advancements in surgical techniques. We hypothesized that bariatric surgery prior to primary THA would mitigate acute postoperative complications and improve implant survivorship. METHODS A retrospective review from 1995 to 2020 identified 88 primary THA procedures in 71 unique patients who previously underwent bariatric surgery (73% Roux-en-Y). This cohort was matched 1:1:1 for age, gender, surgical year, American Society of Anesthesiologists score, and Charlson Comorbidity Index to cohorts of patients with body mass index (BMI) <40 kg/m2 and BMI ≥40 kg/m2. Revisions, reoperations, and acute complications were compared. Subgroup analysis then evaluated historical (pre-2012) relative to contemporary (2012 and after) bariatric procedures. RESULTS Revision rates for bariatric patients were higher relative to controls with low (hazard ratio [HR] 19, P < .01) and high BMI (HR 8, P < .01). Reoperation rates showed a similar increase for bariatric patients when compared to low (HR 9, P < .01) and high BMI (HR 4, P = .01) patients. Moreover, bariatric patients had an increased dislocation risk compared to the low (HR 7, P = .03) and high BMI (HR 17, P < .01) patients. Contemporary bariatric techniques had similar complications, revisions, and reoperations relative to historical procedures. CONCLUSION Morbidly obese patients undergoing THA have increased risks of certain complications, but it is unclear if bariatric surgery improves this risk. This study found that patients undergoing bariatric surgery have worse implant survivorship and higher dislocation rates compared to patients with naturally low and high BMIs. Further investigation into the post-bariatric metabolic state is warranted. LEVEL OF EVIDENCE Prognostic Level IV.
Collapse
Affiliation(s)
- Sean P Ryan
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Cory G Couch
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Stephanie Q Duong
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | | | | | - Daniel J Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| |
Collapse
|
15
|
Does Bariatric Surgery Prior to Primary Total Knee Arthroplasty Improve Outcomes? J Arthroplasty 2022; 37:S165-S169. [PMID: 35202755 DOI: 10.1016/j.arth.2022.02.048] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/02/2022] [Accepted: 02/11/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Recent advancements in bariatric surgical techniques have increased its utilization for the management of morbid obesity prior to total knee arthroplasty (TKA). We hypothesized that bariatric surgery prior to primary TKA would mitigate postoperative complications and improve implant survivorship. METHODS A retrospective review from 1992-2020 identified 205 bariatric surgery patients with subsequent primary TKA. This cohort was matched 1:1:1 to patients without bariatric surgery and with BMI <40 kg/m2 and BMI ≥40 kg/m2. Revisions, reoperations, and 90-day complications were evaluated. Subgroup analysis evaluated bariatric patients with BMI >40 kg/m2 at TKA, the time between surgeries, and compared historical to contemporary bariatric techniques. RESULTS Bariatric patients demonstrated higher revision rates than low (HR 4, P < .01) and high BMI (HR 9, P < .01) controls, and increased reoperations when compared to the low (HR 2, P < .01) and high BMI (HR 6, P < .01) groups. Reoperation for instability was more common in bariatric patients than low (HR 15, P = .01) and high BMI (HR 17, P < .01) groups. Reoperation for infection was higher in bariatric patients relative to the high BMI (HR 6, P = .03), but not the low BMI cohort (HR 3, P = .06). There was no difference in 90-day complications (P = .33). Bariatric patients with high BMI and contemporary bariatric procedures did not significantly impact complications or survivorship, but bariatric surgery >2 years before TKA was associated with higher revision rates (P = .01). CONCLUSION This study found that bariatric surgery patients who undergo primary TKA have worse implant survivorship, mostly related to infection and instability. Further investigation into perioperative optimization is warranted. LEVEL OF EVIDENCE Prognostic Level IV.
Collapse
|
16
|
Kermansaravi M, Lainas P, Shahmiri SS, Yang W, Jazi AD, Vilallonga R, Antozzi L, Parmar C, Kassir R, Chiappetta S, Zubiaga L, Vitiello A, Mahawar K, Carbajo M, Musella M, Shikora S. The first survey addressing patients with BMI over 50: a survey of 789 bariatric surgeons. Surg Endosc 2022; 36:6170-6180. [PMID: 35064321 PMCID: PMC9283149 DOI: 10.1007/s00464-021-08979-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 12/31/2021] [Indexed: 11/27/2022]
Abstract
Background Bariatric surgery in patients with BMI over 50 kg/m2 is a challenging task. The aim of this study was to address main issues regarding perioperative management of these patients by using a worldwide survey. Methods An online 48-item questionnaire-based survey on perioperative management of patients with a BMI superior to 50 kg/m2 was ideated by 15 bariatric surgeons from 9 different countries. The questionnaire was emailed to all members of the International Federation of Surgery for Obesity (IFSO). Responses were collected and analyzed by the authors. Results 789 bariatric surgeons from 73 countries participated in the survey. Most surgeons (89.9%) believed that metabolic/bariatric surgery (MBS) on patients with BMI over 50 kg/m2 should only be performed by expert bariatric surgeons. Half of the participants (55.3%) believed that weight loss must be encouraged before surgery and 42.6% of surgeons recommended an excess weight loss of at least 10%. However, only 3.6% of surgeons recommended the insertion of an Intragastric Balloon as bridge therapy before surgery. Sleeve Gastrectomy (SG) was considered the best choice for patients younger than 18 or older than 65 years old. SG and One Anastomosis Gastric Bypass were the most common procedures for individuals between 18 and 65 years. Half of the surgeons believed that a 2-stage approach should be offered to patients with BMI > 50 kg/m2, with SG being the first step. Postoperative thromboprophylaxis was recommended for 2 and 4 weeks by 37.8% and 37.7% of participants, respectively. Conclusion This survey demonstrated worldwide variations in bariatric surgery practice regarding patients with a BMI superior to 50 kg/m2. Careful analysis of these results is useful for identifying several areas for future research and consensus building. Supplementary Information The online version contains supplementary material available at 10.1007/s00464-021-08979-w.
Collapse
Affiliation(s)
- Mohammad Kermansaravi
- Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, Rasool-e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
- Center of Excellence of European Branch of International Federation for Surgery of Obesity, Hazrat_e Rasool Hospital, Tehran, Iran
| | - Panagiotis Lainas
- Department of Minimally Invasive Digestive Surgery, Antoine-Béclère Hospital, Paris-Saclay University, Clamart, France
- Metropolitan Hospital of Athens, HEAL Academy, Athens, Greece
| | - Shahab Shahabi Shahmiri
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Wah Yang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | | | - Ramon Vilallonga
- Endocrine, Metabolic and Bariatric Unit, Department of General and Digestive Surgery, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain
- ELSAN, Clinique Saint Michel, Centre Chirurgical de L'Obésité, Toulon, France
| | | | - Chetan Parmar
- Department of Surgery, The Whittington Health NHS Trust, London, UK
- University College London Medical School, London, UK
| | - Radwan Kassir
- Department of Digestive Surgery, Centre Hospitalier Universitaire Félix Guyon, St Denis de la Réunion, France
| | - Sonja Chiappetta
- Obesity and Metabolic Surgery Unit, Ospedale Evangelico Betania, Naples, Italy
| | - Lorea Zubiaga
- Miguel Hernandez of Elche University, Alicante, Spain
| | - Antonio Vitiello
- Advanced Biomedical Sciences Department, Naples "Federico II" University, AOU "Federico II", Via S. Pansini 5, 80131, Naples, Italy
| | - Kamal Mahawar
- South Tyneside and Sunderland Foundation NHS Trust, Sunderland, UK
| | - Miguel Carbajo
- Centre of Excellence for the Study and Treatment of Obesity and Diabetes, Valladolid, Spain
| | - Mario Musella
- Advanced Biomedical Sciences Department, Naples "Federico II" University, AOU "Federico II", Via S. Pansini 5, 80131, Naples, Italy.
| | - Scott Shikora
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
17
|
Liu J, Zhong H, Poeran J, Sculco PK, Kim DH, Memtsoudis SG. Bariatric surgery and total knee/hip arthroplasty: an analysis of the impact of sequence and timing on outcomes. Reg Anesth Pain Med 2021; 46:941-945. [PMID: 34462345 DOI: 10.1136/rapm-2021-102967] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/17/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Patients with morbid obesity may require both bariatric surgery and total knee/hip arthroplasty (TKA/THA). How to sequence these two procedures with better outcomes remains largely unstudied. METHODS This cohort study extracted claims data on patients with an obesity diagnosis that received both bariatric surgery and TKA/THA surgery within 5 years of each other (Premier Healthcare database 2006-2019). Overall, 1894 patients received bariatric surgery before TKA or THA, while 1000 patients underwent TKA or THA before bariatric surgery. Main outcomes and measures include major complications (acute renal failure, acute myocardial infarction, other cardiovascular complications, sepsis/septic shock, pulmonary complications, pulmonary embolism, pneumonia, and central nervous system-related adverse events), postoperative intensive care unit utilization, ventilator utilization, 30-day readmission, 90-day readmission, 180-day readmission and total hospital length of stay after the second surgery. Regression models measured the association between the complications and sequence of TKA/THA and bariatric surgery. RESULTS Undergoing TKA/THA before bariatric surgery (compared with the reverse) was associated with higher odds of major complications (7.0% vs 1.9%; adjusted OR 4.8, 95% CI 3.1, 7.6, p<0.001). Similar patterns were also observed for intensive care unit admission, ventilator use postoperatively, 30-day, and 90-day readmissions. Patients who received a second surgery within 6 months of their first surgery exhibited worse outcomes, especially among the TKA/THA first patient cohort. Major complication incidences occurred at 20.5%, 12.5%, 5.1%, 5.0%, 5.8% and 8.5% with time between TKA/THA and bariatric surgery at <6 months, 6 months-1 year, 1-2, 2-3, 3-4 and 4-5 years, respectively. CONCLUSIONS Patients who require both bariatric surgery and TKA/THA should consider bariatric surgery before TKA/THA as it is associated with improved outcomes. Procedures should be staged beyond 6 months.
Collapse
Affiliation(s)
- Jiabin Liu
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA .,Department of Anesthesiology, Weill Cornell Medical College, New York, New York, USA
| | - Haoyan Zhong
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA
| | - Jashvant Poeran
- Depts of Population Health Science & Policy/Orthopedics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Peter K Sculco
- Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - David H Kim
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Weill Cornell Medical College, New York, New York, USA
| | - Stavros G Memtsoudis
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Weill Cornell Medical College, New York, New York, USA
| |
Collapse
|
18
|
Surgeon Decision-Making for Individuals With Obesity When Indicating Total Joint Arthroplasty. J Arthroplasty 2021; 36:2708-2715.e1. [PMID: 33865649 DOI: 10.1016/j.arth.2021.02.078] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/22/2021] [Accepted: 02/27/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Obesity is a risk factor for complications after total joint arthroplasty (TJA). This study analyzed the impact of individual surgeon demographics, financial concerns, and other factors in determining patient candidacy for TJA based on body mass index (BMI). METHODS A 21-question survey was approved by the American Association of Hip and Knee Surgeons Research Committee for distribution to its membership. Objective questions asked about surgeon or hospital BMI thresholds for offering TJA. Subjective questions asked about physician comfort discussing topics including obesity, bariatric surgery, and weight loss before TJA, as well as insurance and age considerations. RESULTS For TJA procedures, 49.9% of surgeons had a BMI cutoff at 40, 24.5% at 45, and 8.3% at 50. At a BMI cutoff of 40, 23.8% of surgeons felt their patient volume would be adversely affected, whereas at a BMI cutoff of 35, 50% of surgeons felt their patient volume would be adversely affected. Surgeons were more likely to not perform total hip arthroplasty on patients with morbid obesity than total knee arthroplasty (P = .037). Significantly more academic surgeons did not have cutoffs for total hip arthroplasty (P = .003) or total knee arthroplasty (P < .001) compared with all other practice settings. CONCLUSION There are myriad factors that affect surgeon BMI thresholds for offering elective TJA including poor outcomes, hospital thresholds, financial considerations, and the well being of the patient. Further work should be performed to minimize the risks associated with TJA while providing the best possible care to patients with morbid obesity.
Collapse
|
19
|
Abstract
Obesity is an independent risk factor for osteoarthritis due to mechanical and inflammatory factors. The gold-standard treatment of end-stage knee and hip osteoarthritis is total joint arthroplasty (TJA). Weight loss decreases progression of osteoarthritis and complications following TJA in patients with obesity. Bariatric surgery allows significant, sustained weight loss and comorbidity resolution in patients with morbid obesity. Existing data describing bariatric surgery on TJA outcomes are limited but suggest a benefit to bariatric surgery prior to TJA. Further studies are needed to determine optimal risk stratification, bariatric procedure selection, and timing of bariatric surgery relative to TJA.
Collapse
MESH Headings
- Arthroplasty, Replacement, Hip/methods
- Arthroplasty, Replacement, Knee/methods
- Bariatric Surgery/methods
- Comorbidity
- Global Health
- Humans
- Obesity, Morbid/epidemiology
- Obesity, Morbid/surgery
- Osteoarthritis, Hip/epidemiology
- Osteoarthritis, Hip/surgery
- Osteoarthritis, Knee/epidemiology
- Osteoarthritis, Knee/surgery
- Weight Loss
Collapse
Affiliation(s)
- Katelyn M Mellion
- Department of Medical Education, Advanced Gastrointestinal Minimally Invasive Surgery and Bariatric Fellowship, Gundersen Health System, 1900 South Avenue C05-001, La Crosse, WI 54601, USA
| | - Brandon T Grover
- Department of Surgery, Gundersen Health System, 1900 South Avenue C05-001, La Crosse, WI 54601, USA.
| |
Collapse
|
20
|
Ighani Arani P, Wretenberg P, Ottosson J, Robertsson O, W-Dahl A. Bariatric surgery prior to total knee arthroplasty is not associated with lower risk of revision: a register-based study of 441 patients. Acta Orthop 2021; 92:97-101. [PMID: 33143505 PMCID: PMC7919889 DOI: 10.1080/17453674.2020.1840829] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Obesity is a considerable medical challenge in society. We investigated the risk of revision for any reasons and for infection in patients having total knee arthroplasty (TKA) for osteoarthritis (OA) within 2 years after bariatric surgery (BS) and compared them with TKAs without BS.Patients and methods - We used the Scandinavian Obesity Surgery Registry (SOReg) and the Swedish Knee Arthroplasty Register (SKAR) to identify patients operated on in 2009-2019 with BS who had had primary TKA for OA within 2 years after the BS (BS group) and compared them with TKAs without prior BS (noBS group). We determined adjusted hazard ratio (HR) for the BS group and noBS group using Cox proportional hazard regression for revision due to any reasons and for infection. Adjustments were made for sex, age groups, and BMI categories preoperatively.Results - 441 patients were included in the BS group. The risk of revision for infection was higher for the BS group with HR 2.2 (95% CI 1.1-4.7) adjusting for BMI before the TKA, while the risk of revision for any reasons was not statistically significant different for the BS group with HR 1.3 (CI 0.9-2.1). Corresponding figures when adjusting for BMI before the BS were HR 0.9 (CI 0.4-2) and HR 1.2 (CI 0.7-2).Interpretation - Our findings did not indicate that BS prior to TKA was associated with lower risk of revision.
Collapse
Affiliation(s)
- Perna Ighani Arani
- Department of Orthopedics, Orebro University Hospital; ,Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro; ,Correspondence:
| | - Per Wretenberg
- Department of Orthopedics, Orebro University Hospital; ,Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro;
| | - Johan Ottosson
- Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro; ,Department of Surgery, Örebro University Hospital; ,Scandinavian Obesity Surgery Registry, Örebro;
| | - Otto Robertsson
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund; ,The Swedish Knee Arthroplasty Register, Lund, Sweden
| | - Annette W-Dahl
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund; ,The Swedish Knee Arthroplasty Register, Lund, Sweden
| |
Collapse
|
21
|
Abstract
PURPOSE OF REVIEW Prosthetic joint infection (PJI) remains a serious concern in lower limb arthroplasty. Despite the significant consequences of PJI, the assessment of the safety and efficacy of preventative measures is challenging due to a low event rate. Notwithstanding, enormous efforts have been made in this arena, and prevention strategies continue to evolve. This review provides an update on contemporary literature (published within the last 5 years) pertaining to infection prevention in primary hip and knee arthroplasty. RECENT FINDINGS Patient optimization has been highlighted as a critical preoperative factor in mitigating PJI risk. Recent evidence emphasizes the importance of preoperative glycaemic control, nutritional status, weight optimization and smoking cessation prior to hip and knee arthroplasty. Perioperatively, attention to detail in terms of surgical skin preparation agent and technique as well as prophylactic antibiotic agent, spectrum, dose and timing is important with statistically and clinically significant differences seen between differing strategies. Intraosseous regional antibiotic administration is an emerging technique with promising preclinical data. Dilute betadine lavage also shows promise. Data supporting bundled interventions continues to grow. A multimodal approach is required in PJI prevention, and attention to detail is important with each element. Patient optimization is critical, as is the execution of the planned perioperative infection prevention strategy.
Collapse
|
22
|
Rudy HL, Cho W, Oster BA, Tarpada SP, Moran-Atkin E. Rapid Bodyweight Reduction before Lumbar Fusion Surgery Increased Postoperative Complications. Asian Spine J 2020; 14:613-620. [PMID: 32213793 PMCID: PMC7595823 DOI: 10.31616/asj.2019.0236] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 11/28/2019] [Indexed: 12/27/2022] Open
Abstract
Study Design Retrospective cohort study. Purpose To determine the effects of massive weight loss on perioperative complications after lumbar fusion surgery (LFS). Overview of Literature Patients who are obese are more likely to experience low back pain, which would require LFS. Nonetheless, they have a higher risk of perioperative complication development compared with individuals who are not obese. Methods Patients who underwent LFS at hospitals that participated in the National Surgical Quality Improvement Program database within the United States between 2005 and 2015. Outcomes included 30-day medical complications, surgical complications, and length of stay (LOS). We analyzed a total of 39,742 patients with the use of the International Classification of Disease, ninth revision codes. The patients were categorized in the following two groups: group 1, individuals with a history of massive weight loss within 6 months before LFS, and group 2, individuals without a history of massive weight loss before surgery. Massive weight loss was defined as loss of 10% of total body weight. Patients with a history of malignancy or chronic disease were excluded from the study. Patients in each group were randomly matched based on age, gender, sex, smoking status, and body mass index. Paired two-tailed Student t-tests were used to compare the outcomes. Results Of the 39,742 patients identified, 129 (0.32%) met the criteria for inclusion in the weight loss group (WL group) and were successfully matched to individuals in the non-weight loss group (non-WL group). Compared with the non-WL group, the WL group had a significantly longer LOS (9.7 vs. 4.0 days, p<0.05), higher surgical site infections (SSIs) (8.0 vs. 3.0, p<0.05), increased number of blood transfusions (40.0 vs. 20.0, p<0.05), and greater deep vein thrombosis (DVTs) (5.0 and 0.00, p<0.05). Conclusions On a nationwide scale, rapid weight loss before LFS is associated with a higher rate of postoperative complications, including SSI and DVTs, longer average LOS, and more frequent blood transfusions.
Collapse
Affiliation(s)
| | - Woojin Cho
- Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Orthopaedic Surgery, Montefiore Medical Center, Bronx, NY, USA
| | | | - Sandip Parshottam Tarpada
- Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Orthopaedic Surgery, Montefiore Medical Center, Bronx, NY, USA
| | - Erin Moran-Atkin
- Department of General Surgery, Montefiore Medical Center, Bronx, NY, USA
| |
Collapse
|
23
|
Brockman BS, Maupin JJ, Thompson SF, Hollabaugh KM, Thakral R. Complication Rates in Total Knee Arthroplasty Performed for Osteoarthritis and Post-Traumatic Arthritis: A Comparison Study. J Arthroplasty 2020; 35:371-374. [PMID: 31606293 DOI: 10.1016/j.arth.2019.09.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 09/09/2019] [Accepted: 09/13/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The number of total knee arthroplasty (TKA) procedures performed in the United States has been increasing. Increased complication rates have been demonstrated in patients with post-traumatic arthritis (PTA) undergoing TKA. However, there remains limited data directly comparing outcomes of TKA performed for osteoarthritis (OA) and PTA. METHODS The National Inpatient Sample was utilized to identify patients undergoing elective TKA between 2006 and 2015 for OA and PTA. The prevalence of preoperative comorbidities and the incidence of postoperative complications including superficial wound infection, deep joint infection, acute deep venous thrombosis, and pulmonary embolus were analyzed. RESULTS Between 2006 and 2015, the National Inpatient Sample database accounted for 1,301,394 patients diagnosed with either PTA (14,206) or OA (1,287,188) undergoing TKA. The incidence of superficial wound infection, deep joint infection, and acute deep venous thrombosis was found to occur at a higher rate in patients with a diagnosis of PTA compared to OA. The incidence of pulmonary embolus was not found to be statistically different between the 2 groups. Patients with PTA had a higher prevalence of drug and alcohol abuse, psychosis, and liver disease, whereas patients with OA had a higher prevalence of obesity, diabetes, heart disease, and lung disease. CONCLUSION This study demonstrates an increased risk of complications in patients undergoing TKA for PTA compared to OA. Surgeons can use this information to help aid in counseling patients preoperatively. Furthermore, these data provide objective evidence that could have implications with regards to establishing bundled payment reimbursement in this patient population.
Collapse
Affiliation(s)
- Bryan S Brockman
- Department of Orthopedic Surgery and Rehabilitation, University of Oklahoma, Oklahoma City, OK
| | - Jeremiah J Maupin
- Department of Orthopedic Surgery and Rehabilitation, University of Oklahoma, Oklahoma City, OK
| | - Samuel F Thompson
- Department of Orthopedic Surgery and Rehabilitation, University of Oklahoma, Oklahoma City, OK
| | - Kimberly M Hollabaugh
- Department of Orthopedic Surgery and Rehabilitation, University of Oklahoma, Oklahoma City, OK
| | - Rishi Thakral
- Department of Orthopedic Surgery and Rehabilitation, University of Oklahoma, Oklahoma City, OK
| |
Collapse
|
24
|
New York Arthroplasty Council (NYAC) Consensus on Reducing Risk in Total Joint Arthroplasty: Obesity. Tech Orthop 2019. [DOI: 10.1097/bto.0000000000000392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
25
|
|
26
|
Safety and efficacy of the sleeve gastrectomy as a strategy towards kidney transplantation. Surg Endosc 2019; 34:2657-2664. [DOI: 10.1007/s00464-019-07042-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 07/24/2019] [Indexed: 12/14/2022]
|
27
|
The Effect of Bariatric Surgery Prior to Lower-Extremity Total Joint Arthroplasty: A Systematic Review. HSS J 2019; 15:190-200. [PMID: 31327952 PMCID: PMC6609675 DOI: 10.1007/s11420-019-09674-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 01/22/2019] [Indexed: 02/07/2023]
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.
Collapse
|
28
|
Preoperative Optimization Checklists Within the Comprehensive Care for Joint Replacement Bundle Have Not Decreased Hospital Returns for Total Knee Arthroplasty. J Arthroplasty 2019; 34:S108-S113. [PMID: 30611521 DOI: 10.1016/j.arth.2018.12.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 12/06/2018] [Accepted: 12/07/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The Comprehensive Care for Joint Replacement (CJR) model has resulted in the evolution of preoperative optimization programs to decrease costs and hospital returns. At the investigating institution, one center was not within the CJR bundle and has dedicated fewer resources to this effort. The remaining centers have adopted an 11 metric checklist designed to identify and mitigate modifiable preoperative risks. We hypothesized that this checklist would improve postoperative metrics that impact costs for total knee arthroplasty (TKA) patients eligible for participation in CJR. METHODS Patients undergoing TKA from 2014 to 2018 were retrospectively reviewed. Only patients with eligible participation in CJR were included. Outcome variables including length of stay, disposition, 90-day emergency department visits, and hospital readmissions were explored. Analysis was performed to determine differences in outcomes between CJR participating and non-CJR participating hospitals within the healthcare system. RESULTS In total, 2308 TKA patients including 1564 from a CJR participating center and 744 from a non-CJR center were analyzed. There was no significant difference in patient age or gender. Patients at the non-CJR hospital had significantly higher body mass index (P < .001) and American Society of Anesthesiologists scores (P < .001), while those in the CJR network had fewer skilled nursing facility discharges (P = .028) and shorter length of stay (P < .001). However, there was no reduction in 90-day emergency department visits or readmissions. CONCLUSION The resources utilized at CJR participating hospitals, including patient optimization checklists, did not effectively alter patient outcomes following discharge. Likely, a checklist alone is insufficient for risk mitigation and detailed optimization protocols for modifiable risk factors must be investigated.
Collapse
|
29
|
Li S, Luo X, Sun H, Wang K, Zhang K, Sun X. Does Prior Bariatric Surgery Improve Outcomes Following Total Joint Arthroplasty in the Morbidly Obese? A Meta-Analysis. J Arthroplasty 2019; 34:577-585. [PMID: 30528132 DOI: 10.1016/j.arth.2018.11.018] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 10/26/2018] [Accepted: 11/12/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND There remains a controversy regarding the risks in subsequent total joint arthroplasty (TJA) with and without previous bariatric surgery (BS). We performed a meta-analysis based on the current evidence-based study to determine the influences of prior BS on the short-term and long-term outcomes following TJA. METHODS From the inception to July 2018, the EMBASE, PubMed, Web of Science, and Cochrane Library electronic databases were searched for all relevant English language trials. The primary outcome measures were complications and revision, whereas the secondary outcomes included length of stay and operative time. Short-term follow-up was defined as that from hospital discharge to 90 days, and long-term follow-up was defined as more than 1 year. RESULTS A total of 9 studies with 38,728 patients were included. Overall, medical comorbidities were higher in the BS group compared with the control morbid obesity group before TJA. Our meta-analysis revealed that BS prior to TJA was associated with reduced short-term medical complications, length of stay, and operative time. However, BS did not reduce the short-term risks for superficial wound infection or venous thromboembolism, and the long-term risks for dislocation, periprosthetic infection, periprosthetic fracture, and revision. Subgroup analysis identified a significant reduction in the risk of short-term periprosthetic infection in the BS group after total knee arthroplasty, but not after total hip arthroplasty. CONCLUSION BS prior to TJA was associated with partially improved short-term outcomes after TJA. However, BS did not improve the risks for long-term outcomes. Limited by relatively higher comorbidities burden, the short-term benefits of BS should be further revealed by high-quality, controlled study in the future.
Collapse
Affiliation(s)
- Shuxiang Li
- Department of Articular Orthopaedics, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, People's Republic of China
| | - Xiaomin Luo
- Department of Articular Orthopaedics, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, People's Republic of China
| | - Han Sun
- Department of Articular Orthopaedics, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, People's Republic of China
| | - Kun Wang
- Department of Articular Orthopaedics, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, People's Republic of China
| | - Kaifeng Zhang
- Department of Articular Orthopaedics, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, People's Republic of China
| | - Xiaoliang Sun
- Department of Articular Orthopaedics, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, People's Republic of China
| |
Collapse
|
30
|
Abstract
Despite the development of newer preventative measures, the rate of infection continues to be approximately 1% for patients undergoing total joint arthroplasty (TJA). The extent of the infection can range from a mild superficial infection to a more serious periprosthetic joint infection (PJI). PJIs not only play a significant role in the clinical well-being of the TJA patient population, but also have substantial economic implications on the health care system. Several approaches are currently being used to mitigate the risk of PJI after TJA. The variety of prophylactic measures to prevent infection after TJA must be thoroughly discussed and evaluated.
Collapse
|
31
|
Cohen-Rosenblum A, Kew ME, Johnson-Mann C, Browne JA. Roux-en-Why? What the Orthopaedic Surgeon Needs to Know About Bariatric Surgery. JBJS Rev 2018; 6:e3. [PMID: 30531201 DOI: 10.2106/jbjs.rvw.18.00018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Anna Cohen-Rosenblum
- Department of Orthopaedic Surgery (A.C.-R., M.E.K., and J.A.B.) and Division of General Surgery, Department of Surgery (C.J.-M.), University of Virginia Health System, Charlottesville, Virginia
| | | | | | | |
Collapse
|