Does bariatric surgery prior to total hip or knee arthroplasty reduce post-operative complications and improve clinical outcomes for obese patients? Systematic review and meta-analysis

Aims: To determine whether, based on the current literature, bariatric surgery prior to total hip (THR) or total knee replacement (TKR) reduces complication rates and improves outcome following arthroplasty.

Materials and Methods: Systematic literature search was undertaken of published and unpublished databases on the 5th November 2015. All papers reporting studies comparing people who had undergone bariatric surgery versus not prior to THR or TKR were included. Each study was assessed using the Downs and Black appraisal tool. A meta-analysis of risk ratios (RR) and 95% confidence intervals was performed to determine the incidence of complications including wound infection, deep vein thrombosis (DVT), pulmonary embolism (PE), joint revision and mortality.

Results: From 156 potentially studies, five papers were eligible. In total 23,348 (657 bariatric surgery, 22,691 non-bariatric surgery) participants were analysed. The evidence-base was moderate in quality. There was no statistically significant difference in outcomes such as superficial wound infection (RR: 1.88), deep wound infection (RR: 1.04), DVT (RR: 0.57), PE (RR: 0.51), joint revision (RR: 1.24) or mortality (RR: 1.25) between the two groups.

Conclusions: For the majority of peri-operative outcomes, bariatric surgery prior to THR or TKR does not significantly reduce complication rates or improve clinical outcomes.

Clinical Relevance: This study questions the previous notion that bariatric surgery prior to joint replacement may improve clinical outcomes for people who are obese or morbidly obese.