Outcomes of Total Knee Arthroplasty in Patients With and Without Prior Bariatric Surgery
Overview
This study compared pain, function, and satisfaction one year after total knee arthroplasty (TKA) in patients with prior bariatric surgery (BS) versus those without. Patients with BS had statistically worse patient-reported outcomes despite significant weight loss prior to TKA. Satisfaction levels were similar between groups.
Background
Obesity is a growing medical challenge linked to increased complications and mortality after TKA. Bariatric surgery is effective for long-term weight loss but its impact on postoperative patient-reported outcomes (PROs) after TKA has not been previously studied. Understanding whether prior BS affects pain, function, and satisfaction after TKA is clinically important given the rising number of obese patients undergoing knee replacement.
Data Highlights
Characteristic
BS Group (n=44)
No BS Group (n=3,524)
Mean Age (years)
56
60
Female (%)
86%
57%
ASA Score 2 (%)
70%
62%
Mean BMI Reduction after BS
14.2 (SD 3.3)
NA
Mean Total Weight Loss (%)
33.6% (SD 12%)
NA
Mean Time Between BS and TKA (years)
1.1 (SD 0.43)
NA
Key Findings
Patients with prior BS were younger and predominantly female compared to those without BS.
Despite significant weight loss (mean BMI reduction 14.2), the BS group reported statistically worse KOOS scores for pain and ADL function one year after TKA.
There was no significant difference in patient satisfaction with TKA between BS and no BS groups at one year.
The BS group had a higher risk of revision due to infection as previously reported.
The study adjusted for confounders including age, sex, and preoperative KOOS scores but not BMI due to minimal difference between groups.
Clinical Implications
Clinicians should be aware that patients undergoing TKA after bariatric surgery may experience worse pain and functional outcomes despite weight loss. This suggests that prior BS does not necessarily translate into improved postoperative knee function or pain relief. Patient counseling and postoperative management may need to be tailored accordingly.
Conclusion
Prior bariatric surgery before TKA is associated with worse patient-reported pain and function outcomes one year postoperatively, although satisfaction levels remain comparable. Further research is needed to optimize care for this patient population.
References
Scandinavian Obesity Surgery Register and Swedish Knee Arthroplasty Register Data, 2007-2019 -- Outcomes of Total Knee Arthroplasty in Patients With and Without Prior Bariatric Surgery
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