Outcomes of Bariatric Surgery Prior to Knee Replacement Arthroplasty in Obese Patients: An Integrative Review of the Literature

Abstract

Background: Review of literature reveals that many obese patients who are requiring total knee replacement do not lose appropriate weight prior to the procedure, which impairs the healing process. Even though bariatric surgery is often a last-resort option for some patients; those that undergo the procedure could experience better outcomes post-knee replacement.

Objectives: The purpose of this integrative literature review was to identify contributing risk factors of obese patients that elect bariatric surgery prior to total knee replacement. Lastly, to evaluate the effectiveness of this route of weight loss prior to the arthroplasty procedure.

Method: A computerized search of the literature was conducted using PubMed, Cumulative Index to Nursing and Health Literature (CINAHL), and Ovid MEDLINE. A total of 12 articles were used for this integrated literature review.

Results: Four contributing risk factors were identified that influence the outcomes of obese patients that elect to have bariatric surgery prior to a knee replacement. The literature revealed that more comorbidities, increased surgical revision rates, increased post-operative complications, and increased length of hospital stay were such risk factors.

Conclusions: Review of literature supports that prior bariatric surgery is not the only factor on the recovery of obese patients from total knee replacement. The patients’ comorbidities need to be examined when devising a plan of care for that individual. The greater risk of poor wound healing, post-operative infection, required revision procedures, and length of hospital stay should be taken into consideration to better serve obese patients undergoing a total knee replacement.

Key Words: Obesity, bariatric surgery, arthroplasty, total knee arthroplasty, and total knee replacement