The Effect of Bariatric Surgery on the Rate of 90-Day Complication Following Elective Primary Total Joint Arthroplasty.

Background: The potential benefits of preoperative weight loss with bariatric surgery in reducing short-term complications of total joint arthroplasty (TJA) have been questioned. We studied the odds of 90-day postoperative complications by comparing TJA patients who had a history of bariatric surgery to a control group.

Methods: There were 678 patients who had undergone bariatric surgery before TJA (199 total hip arthroplasty [THA], 479 total knee arthroplasty [TKA]) matched 1:4 for body mass index (BMI) at the time of TJA, age, sex, replaced joint, and American Society of Anesthesiologists Class with a control group of 2,301 TJA (644 THA, 1,657 TKA) patients who did not have bariatric surgery. Matching was performed using propensity scores with refined calipers to ensure comparability. The 90-day complication data was collected through chart review. The primary outcome was the incidence of Hip Society or Knee Society complications, emergency department visits, and wound complications requiring deviation from the standard of care.

Results: There were significantly more complications in the THA study than in the control group (11.6 and 6.3%, respectively, P = 0.018). The THA study group demonstrated 1.96 times higher odds of developing complications compared to controls (95% CI [confidence interval] 1.12 to 3.43). There were similar rates of complications in the study and control TKA groups (12.4 and 10.1%, respectively, P = 0.129). Wound-related complications were more common in the THA study group affecting 4.5 and 1.4% of study and control patients, respectively (P = 0.02).

Conclusions: While Bariatric surgery remains an effective weight loss intervention, its utility as a risk-reduction strategy before THA is not supported by our findings.