Dataset Information

Bariatric Surgery Following Total Shoulder Arthroplasty Increases the Risk for Mechanical Complications Including Instability and Prosthetic Loosening.

ABSTRACT:

Background

While extensive literature has been published on the risks and benefits of bariatric surgery (BS) prior to and following lower-extremity arthroplasty, no similar investigations have been performed on the impact of BS prior to total shoulder arthroplasty (TSA).

Purpose

The objective of the present study was to compare the incidence of mechanical complications in morbidly obese patients who undergo TSA: those who undergo BS following TSA compared with those who do not undergo BS, and those who undergo BS after TSA compared with those who undergo BS prior to TSA.

Methods

A Medicare database was queried for morbidly obese patients who underwent BS either before or after TSA, as well as those who underwent TSA but no BS. Of 12,277 morbidly obese patients who underwent TSA between 2005 and 2014, 304 underwent BS (165 of them prior to TSA and 139 following TSA) and 11,923 did not undergo BS. Rates of mechanical complications were then compared between groups using a logistic regression analysis.

Results

Patients who underwent BS after TSA had significantly higher rates of mechanical complications (12.9%) compared to controls (8.8%) or patients who underwent prior BS (7.9%). Patients who underwent BS after TSA had higher rates of both instability (7.9%) and loosening (8.6%) than did controls (5.1 and 4.9%, respectively) or patients who underwent BS before TSA (4.8 and 4.2%, respectively).

Conclusions

BS following TSA is associated with increased rates of mechanical complications, including instability and loosening, compared to BS prior to TSA. These findings suggest that it may be prudent to consider performing BS prior to TSA in morbidly obese patients, rather than waiting until after TSA is performed.

SUBMITTER: Cancienne JM

PROVIDER: S-EPMC6031543 | biostudies-literature | 2018 Jul

REPOSITORIES: biostudies-literature

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Publications

Bariatric Surgery Following Total Shoulder Arthroplasty Increases the Risk for Mechanical Complications Including Instability and Prosthetic Loosening.

Cancienne J M JM Camp Christopher L CL Brockmeier Stephen F SF Gulotta Lawrence V LV Dines David M DM Werner B C BC

HSS journal : the musculoskeletal journal of Hospital for Special Surgery 20171127 2

<h4>Background</h4>While extensive literature has been published on the risks and benefits of bariatric surgery (BS) prior to and following lower-extremity arthroplasty, no similar investigations have been performed on the impact of BS prior to total shoulder arthroplasty (TSA).<h4>Purpose</h4>The objective of the present study was to compare the incidence of mechanical complications in morbidly obese patients who undergo TSA: those who undergo BS following TSA compared with those who do not und ...[more]

PMID: 29983650

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Project description:ImportancePeople with severe obesity who undergo a total knee arthroplasty (TKA) for osteoarthritis (OA) are at higher risk of short-term and long-term complications compared with people with reference (<30) body mass index (BMI; weight in kilograms divided by height in meters squared). It is not known whether weight loss before TKA modifies this risk.ObjectiveTo determine whether outcomes are improved by undergoing bariatric surgery before TKA in people with BMI greater than or equal to 35 and end-stage OA.Design, setting, and participantsThis parallel-group, assessor-blinded, randomized clinical trial was conducted between May 2012 and June 2020 with a minimum follow-up of 12 months after TKA. TKA was performed at a tertiary referral university-affiliated public hospital, and bariatric surgery was performed at a private hospital facility and a university-affiliated private practice. Data analysis was performed from February to July 2021.InterventionsBariatric surgery compared with usual weight management advice (treatment as usual [TAU]) in people scheduled for TKA.Main outcomes and measuresThe primary outcome was complications of TKA measured by a composite of death from any cause, perioperative or postoperative complications resulting in a discharge delay, unplanned procedure, or readmission for at least 12 months after TKA. Secondary outcomes included hospital bed day utilization, anthropomorphic measures, and patient-reported outcomes.ResultsEighty-two patients waiting for TKA were randomized to undergo bariatric surgery (41 patients) or TAU (41 patients). Of the 82 participants, 66 (80.5%) were women, the mean (SD) age was 57.8 (4.9) years, and the mean (SD) BMI was 43.8 (5.5). Thirty-nine participants (95.1%) in the intervention group underwent laparoscopic adjustable gastric banding, and 29 (70.7%) subsequently underwent TKA. Thirty-nine patients (95.1%) in the TAU group underwent TKA. Six patients (14.6%) in the intervention group incurred the primary outcome (median follow-up, 24 months), compared with 15 (36.6%) in the TAU group (median follow-up, 27 months) (difference, 22.0%; 95% CI, 3.7% to 40.3%; P = .02). The between-group difference in BMI at 12 months was -6.32 (95% CI, -7.90 to -4.50; P < .001) in favor of the intervention group. TKA was declined by 12 participants (29.3%) in the intervention group because of symptom improvement, whereas 2 participants (4.9%) in the TAU group declined TKA (difference, 24.4%; 95% CI, 9.0% to 39.8%; P = .003).Conclusions and relevanceWeight loss following bariatric surgery reduced the risk of complications of TKA in people with BMI greater than or equal to 35. Significantly fewer participants required TKA following weight loss, contributing to this finding.Trial registrationAustralian New Zealand Clinical Trials Registry Number: ACTRN12611001178932.

Dataset Information

Bariatric Surgery Following Total Shoulder Arthroplasty Increases the Risk for Mechanical Complications Including Instability and Prosthetic Loosening.

Background

Purpose

Methods

Results

Conclusions

Publications

Bariatric Surgery Following Total Shoulder Arthroplasty Increases the Risk for Mechanical Complications Including Instability and Prosthetic Loosening.

Similar Datasets

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