Does Prior Bariatric Surgery Affect Implant Survivorship and Complications Following Primary Total Hip Arthroplasty/Total Knee Arthroplasty?

Background: The purpose of this study is to evaluate the impact of prior bariatric surgery on survivorship, outcome, and complications following primary total hip arthroplasty (THA)/total knee arthroplasty (TKA). Methods: Using the Medicare 5% part B data from 1999 to 2012, we analyzed patients who underwent primary THA (n = 47,895) and primary TKA (n = 86,609). Patients with prior bariatric surgery before arthroplasty were compared to patients with other common metabolic conditions. Kaplan-Meier risk of revision THA/TKA for those with and without bariatric surgery and each of the metabolic bone conditions was calculated. The risk for infection was also evaluated. Regression analysis was used to determine the relative risk of revision at various time intervals for those with and without each of the metabolic conditions. Analysis was also adjusted for the metabolic conditions, age, gender, socioeconomic status, and Charlson comorbidity index. Results: The prevalence of patients with prior bariatric surgery within 24 months of primary THA/TKA was 0.1%. Benchmarked against other common chronic metabolic conditions, bariatric surgery prior to THA was not associated with an increased risk for revision surgery at all measured intervals but positively correlated with increased risk for developing infections. Conversely, patients undergoing primary TKA following bariatric surgery were at increased risk for revision compared to controls but not at increased risk for infection. Conclusion: The impact of bariatric surgery prior to elective THA/TKA remains unclear. These patients remain at increased risk for infections following THA and revisions following TKA. (C) 2018 Published by Elsevier Inc.