Knee

Bariatric surgery effective pre-TKA X-ref

World literature is full of reports on the health economic burden, outcomes and complication rates associated with the obesity epidemic in the Western world. However, there is little data to support decision making surrounding pre-arthroplasty bariatric surgery. Using the now ‘gold standard’ computer modeling techniques, taking into account health economic data, complications data and outcomes data from other studies, researchers in New York (USA) set out to establish the most cost-effective approach to tackling the growing worldwide obesity epidemic, and the associated osteoarthritis.¹ It is well established that obese patients have a high rate of failed non-operative treatment and that these patients are candidates for total knee arthroplasty (TKA). What is not clear, on the other hand, is the impact of greater risks associated with infection, implant failure, and poorer clinical outcomes. Previous studies have evaluated outcomes of bariatric surgery before TKA, and the results are conflicting. Some studies have shown fewer complications, while other studies have not been able to establish an improvement in outcomes. The use of a Markov modeling approach to study the health economics of pre-arthroplasty bariatric surgery should help to unpick this puzzle. The authors established that morbidly obese patients undergoing bariatric surgery prior to arthroplasty had higher quality-adjusted life year (QALY) improvements, with an incremental cost-effectiveness ratio (ICER) of around $14 000 per QALY, well below the cost-effectiveness threshold. Given that morbidly obese patients who underwent pre-operative bariatric surgery prior to TKA had, overall, increased savings per QALY, it would seem to make sense that morbidly obese patients should be encouraged to undergo bariatric surgery two years prior to TKA in order to maximise the benefits of their arthroplasty.