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. 2024 Sep 1;106-B(9):935-941.
doi: 10.1302/0301-620X.106B9.BJJ-2023-1369.R1.

Sleeve gastrectomy prior to primary total hip and total knee arthroplasty is associated with increased risk of early complications

Nikhil Ailaney  1 , Paul G Guirguis  1 , John G Ginnetti  1 , Rishi Balkissoon  1 , Thomas G Myers  1 , Gabriel Ramirez  1   2 , Caroline P Thirukumaran  1   2 , Benjamin F Ricciardi  1   2
Affiliations

Sleeve gastrectomy prior to primary total hip and total knee arthroplasty is associated with increased risk of early complications

Nikhil Ailaney et al. Bone Joint J. .

Abstract

Aims: The purpose of this study was to determine the association between prior sleeve gastrectomy in patients undergoing primary total hip and knee arthroplasty, and 90-day complications, incidence of revision arthroplasty, and patient-reported outcome scores at final follow-up.

Methods: This is a retrospective, single-centre analysis. Patients undergoing primary hip or knee arthroplasty with a prior sleeve gastrectomy were eligible for inclusion (n = 80 patients). A morbidly obese control group was established from the same institutional registry using a 1:2 match, for cases:controls with arthroplasty based on propensity score using age, sex, pre-sleeve gastrectomy BMI, Current Procedural Terminology code to identify anatomical location, and presurgical haemoglobin A1C. Outcomes included 90-day complications, incidence of revision arthroplasty, and patient-reported outcome scores at final follow-up. Multivariable logistic regressions evaluated associations of underlying preoperative demographic and treatment characteristics with outcomes.

Results: Complications within 90 days of surgery were increased in the sleeve gastrectomy group relative to the obese control group after controlling for underlying preoperative demographic characteristics (odds ratio (OR) 4.00 (95% CI 1.14 to 13.9); p = 0.030). Postoperative revisions were similar in the sleeve gastrectomy group relative to the obese control group after controlling for underlying preoperative demographic characteristics (OR 17.8 (95% CI 0.64 to 494.3); p = 0.090). Patient-Reported Outcomes Measurement Information System (PROMIS) depression decreased by a greater amount from pre- to postoperative in the obese controls relative to the sleeve gastrectomy group (OR 4.04 (95% CI 0.06 to 8.02); p = 0.047). PROMIS pain interference and physical function change from pre- to postoperative was not associated with sleeve gastrectomy status.

Conclusion: We found a higher rate of complications at 90 days in patients who underwent sleeve gastrectomy prior to primary hip or knee arthroplasty relative to a matched, obese control population. Prosthetic revision rates were similar between the two groups, while improvements in PROMIS depression scores were larger in the obese cohort. This study suggests that sleeve gastrectomy to achieve preoperative weight loss prior to arthroplasty surgery may not mitigate early complication risks in obese patient populations.

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Conflict of interest statement

C. P. Thirukumaran reports a grant from the National Institutes of Health, and payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Brown University, Boston University, the National Institutes of Health, Oxford University Press, and Veterans Affairs, all of which are unrelated to this study. C. P. Thirukumaran also reports a leadership or fiduciary role in the Orthopaedic Research Society, and editorial roles in Anesthesia and Analgesia and Current Osteoporosis Reports. B. Ricciardi reports funding from the National Institutes of Health and Johnson & Johnson, and honoraria unrelated to this study from Mass General Brigham. B. Ricciardi is also an editorial board member on Clinical Orthopaedics and Related Research, HSS Journal, The Knee, and Arthroplasty Today, and is a committee member of the American Academy of Orthopaedic Surgery and AAHKS.

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