Introduction
Methods
Results
Authors | Year | Study time course | CEBM rating | Revised MINORS Score (quality rating) 16 possible points for non-comparative, 24 possible points if comparative | Overall number of patients undergoing TJA | Patients undergoing bariatric surgery before TJA | Notes | |
---|---|---|---|---|---|---|---|---|
Number | Percent of overall patients | |||||||
Parvizi et al. [31] | 2000 | Retrospective | 4 | 8/16 (moderate quality) | 7 | 7 | 100% | |
Kulkarni et al. [15] | 2010 | Retrospective | 3b | 20/24 (high quality) | 68 | 31 | 45.6% | Some complications data pooled with THA |
Severson et al. [37] | 2012 | Retrospective | 3b | 16/24 (moderate quality) | 125 | 86 | 20% | |
Werner et al. [43] | 2014 | Retrospective | 3b | 19/24 (high quality) | 78,036 | 219 | 0.3% | |
Inacio et al. [17] | 2014 | Retrospective | 3b | 19/24 (high quality) | 8550 TKA, 2653 THA | 134 TKA, 37 THA | 0.7% | Complications data pooled with THA |
Martin et al. [22] | 2015 | Retrospective | 3b | 19/24 (high quality) | 364 | 91 | 25% | |
Nickel et al. [29] | 2016 | Retrospective | 3b | 21/24 (high quality) | 39,014 | 5918 | 15.2% | |
Nearing et al. [28] | 2016 | Retrospective | 3b | 17/24 (moderate quality) | 102 | 36 | 35.3% | Data pooled with THA |
McLawhorn et al. [24] | 2017 | Retrospective | 3b | 19/24 (high quality) | 5272 | 2636 | 50% | |
Schwarzkopf et al. [36] | 2017 | Retrospective | 3b | 19/24 (high quality) | 1017 | 1017 | 100% | |
Lee et al. [19] | 2018 | Retrospective | 3b | 19/24 (high quality) | 86,609 | 70 | 0.1% | |
Liu et al. [20] | 2018 | Retrospective | 3b | 19/24 (high quality) | 343,710 | 1478 | 25% | Data pooled with THA |
Watts et al. [42] | 2018 | Retrospective | 3b | 19/24 (high quality) | 141 | 47 | 33.3% |
Complications
Peri-Operative and Early (Less than 30 Days) Complications
Authors | Groups of patients analyzed as determined by study | Aggregate of complications observed for, reported, and/or analyzed | |||
---|---|---|---|---|---|
Parvizi et al. [31] | 14 patients who had BS before TJA | Hodgkin’s lymphoma, mortality (due to lung cancer), previous femoral fracture, superficial wound infection, patellofemoral pain, wound infection, bilateral deep vein thrombosis, revision needed, deep vein thrombosis, depression/para-suicide | |||
Kuklarni et al. [15] | 53 patients who had BS prior TJA 90 patients who had BS after TJA | 30-day complications Myocardial infarction Cerebrovascular accident C. difficile infection Renal failure Transient ischemic attack Lower respiratory tract infection Joint infection Dislocation Readmission Revision | 90-day complications Mortality deep vein thrombosis Pulmonary embolus | 18-month complications Mortality hip dislocation Dislocation Readmission Revision | 1-year complication Hip revision |
Severson et al. [37] | 39 patients who had TKA before BS 25 patients who had BS within 2 years prior TKA 61 patients who had BS > 2 years prior TKA | Urinary tract infections, deep vein thrombosis, manipulation of joint post-operative arrhythmia, post-operative wound dehiscence (requiring wound revision), post-operative respiratory distress (requiring admission to ICU), deep infections of knee, delayed wound healing, intraoperative lateral femoral condyle fracture, post-operative acute renal failure, pulmonary embolism, acute cholecystitis, post-operative myocardial infarction, post-operative respiratory failure, revisions resulting from stiffness, osteolysis/polywear, osteolysis, acute periprosthetic fracture of the tibia, acute hematogenous infection requiring polyethylene liner exchange, deep infections | |||
Werner et al. [43] | 66,523 non-obese patients who had TKA without BS 11,294 morbidly obese patients who had TKA without BS 219 morbidly obese patients who had TKA post-BS | Major complications: cerebrovascular accident, diagnosis of post-operative infection, deep vein thrombosis, post-operative irrigation and debridement, acute myocardial infarction, respiratory failure, pulmonary embolism | |||
Minor complications: acute renal failure, pneumonia, post-operative blood transfusion, urinary tract infection, stiffness and/or manipulation under anesthesia, stiffness requiring lysis of adhesions | |||||
Inacio et al. [17] | 69 patients who had BS > 2 years prior TJA 102 patients who had BS within 2 years prior TJA 11,032 patients who had TJA without BS | 30-day complications Deep surgical site infection Superficial surgical site infection Death Pulmonary embolism Deep vein thrombosis Any cause of revision Septic cause of revision Readmission | 90-day complications Deep surgical site infection Superficial surgical site infection Death Pulmonary embolism Deep vein thrombosis Any cause of revision Septic cause of revision Readmission | 1-year complications Deep surgical site infection Superficial surgical site infection Death Pulmonary embolism Deep vein thrombosis Any cause of revision Septic cause of revision | |
Martin et al. [22] | 91 patients who had BS before TKA 91 patients (with a BMI comparable to the BMI of the patients pre-BS) who had TKA with no BS 182 patients (with a BMI comparable to the BMI of the patients post-BS) who had TKA with no BS | Death, heart failure, myocardial infarction, deep vein thrombosis, pulmonary embolus, respiratory failure, pneumonia, urinary tract infection, acute renal failure, stroke, revisions | |||
Nickel et al. [29] | 5914 patients who had BS before TKA 6480 patients with a BMI > 40 with no BS before TKA 26,616 patients with a BMI < 25 with no BS before TKA | 30-day complications Death Stroke Pneumonia Myocardial infarction Deep vein thrombosis Pulmonary embolus Urinary tract infection Heart failure Acute renal failure Respiratory failure | 90-day complications Periprosthetic infection Vascular/neuro injury Manipulation of joint Revision Extensor rupture | Minimum 2-year complications Periprosthetic infection Vascular/neuro injury Manipulation of joint Revision Extensor rupture | |
Nearing et al. [28] | 36 patients who had TJA before BS 66 patients who had TJA after BS | Surgical site infection, hematoma, venous thromboembolism, bleed requiring transfusion, periprosthetic infection, re-interventions (including revision, re-operation, manipulation, dislocation) | |||
McLawhorn et al. [24] | 2636 patients who had BS prior TKA 2636 morbidly obese patients who did not have BS prior TKA | Stroke, mechanical complication of joint (including dislocation, loosening, breaking of implant, periprosthetic osteolysis), infection/inflammatory response of any kind (wound related or other post-operative infection/inflammatory response), sepsis, urinary tract infection, pneumonia, ileus, pulmonary embolism, deep vein thrombosis, revisions | |||
Schwarzkopf et al. [36] | 1017 patients who had BS prior TKA | 90-day complications Pulmonary embolism, deep vein thrombosis, acute myocardial infarction, respiratory failure, cerebrovascular event, urinary tract infection, blood transfusion, cardiac complications, peripheral vascular disease, respiratory complications, gastrointestinal complications, pneumonia, acute renal failure, acute cholecystitis, central nervous system problems, hematoma/seroma, wound dehiscence, post-operative infection, post-operative anemia | |||
Lee et al. [19] | 70 patients who had BS prior TKA 86,539 patients who had only TKA | 0.5-year revision risk Revision for PJI | 1-year revision risk Revision for PJI | 2-year revision risk Revision for PJI | 5-year revision risk Revision for PJI |
Liu et al. [20] | 1478 patients who had BS prior TKA 60,259 patients who had obesity, no BS prior to TKA 281,973 patients who had no obesity or BS prior to TKA | 30- and 90-day, 1-year readmission rate PJI, Dislocation, osteoarthritis, atrial fibrillation, cellulitis and abscess of leg, hematoma, septicemia, periprosthetic fracture | |||
Watts et al. [42] | 47 patients who had BS prior to THA 94 patients who did not have BS prior to THA | Up to 5-year re-operation, revision surgery and PJI |