Perspective from Arthur L. Malkani, MD
March 19, 2018
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Obese patients’ THA reoperation, revision risk reduceable with bariatric surgery

Nutritional labs may show malnutrition is a cause of complications in patients who underwent bariatric surgery.

Perspective from Arthur L. Malkani, MD
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Obese patients who underwent bariatric surgery prior to total hip arthroplasty had a lower risk of a short-term to mid-term reoperation or revision, according to research findings.

J. Ryan Martin, MD, of OrthoCarolina, and his colleagues matched 94 patients who were obese and undergoing total hip arthroplasty (THA) with 47 patients who underwent bariatric surgery followed by THA based on prebariatric BMI, sex, age and date of THA.

They saw an improvement in mean BMI among patients who underwent bariatric surgery and had a mean BMI of 35.3 kg/m2 at the time of THA.

“We noted the lowest BMI at 2 years with a slight increase at 5 [years] and 10 years,” Martin said.

The patients were matched for BMI before bariatric surgery and the obese patients’ mean BMI of 50.2 kg/m2 and the bariatric surgery cohort’s mean BMI was 49.7 kg/m2.

The clinical outcome measures used were rates of reoperation, revision and periprosthetic joint infection (PJI).

“We defined reoperation as any return to the operating room, revision as any removal or exchange of the component, and PJI rates per the Musculoskeletal Infection Society criteria,” Martin said.

Patients who were obese had a significantly higher reoperation rate and PJI was the number one cause of reoperation in both cohorts. Patients who were obese also had a significantly higher revision rate compared with patients who underwent bariatric surgery, Martin noted.

“Taking a look at our reoperation and revision rates, there were 21 reoperations in the control cohort, nine of which were secondary to PJI,” Martin said. “In our bariatric cohort, there were five reoperations with two secondary PJI.”

Among patients in the obese cohort who had an infection, he noted four patients underwent head liner exchange and five underwent a two-stage exchange. However, among infected patients in the bariatric surgery patient population, one patient underwent head liner exchange and one underwent a two-stage exchange.

In an interview with Orthopedics Today, Martin said future research should consider nutritional labs, which their study did not cover. These labs, he said, help identify whether malnourishment is why the complications occurred in patients who underwent bariatric surgery.

“Determining preoperative nutrition would likely improve outcomes in both patient populations (obese and bariatric patients) as multiple studies have demonstrated nutritional deficiencies are common,” Martin said in the interview. “Preoperative labs may help surgeons guide the timing of surgery and potentially nutritionally optimize the patient to decrease complications.” – by Casey Tingle

Reference:

Watts C, et al. Paper #408. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 14-18, 2017; San Diego.

For more information:

J. Ryan Martin, MD, can be reached at OrthoCarolina-Matthews, 710 Park Center Dr., Matthews, NC 28105; email: johrmart@gmail.com.

Disclosure: Martin reports no relevant financial disclosures.