Before Knee Replacement, This Surgery May Help

Bariatric surgery before knee replacement surgery may be cost-effective way to improve outcomes

(RxWiki News) Getting surgery before a knee replacement may seem counterintuitive. But, for some patients, getting one type of surgery could be a cost-effective way to improve outcomes.

For obese patients, bariatric (weight loss) surgery before knee replacement surgery may improve overall outcomes, according to a new study, which used a computer model to find these results.

"The computer model supports bariatric surgery prior to total knee replacement as a cost-effective option for improving outcomes in morbidly obese patients with end-stage knee osteoarthritis," said lead study author Alexander McLawhorn, MD, of the Hospital for Special Surgery in New York City, in a press release.

Dr. McLawhorn and colleagues designed their computer model to compare the cost-effectiveness of undergoing knee joint replacement immediately to delaying joint replacement to have bariatric surgery first. The patients within the model were all obese and had advanced knee osteoarthritis.

In knee osteoarthritis, the cartilage in the knee joint wears down over time. As cartilage wears down, the bones may rub together — creating pain and inflammation. Obesity has been tied to increased wear and tear on knee joints.

Bariatric surgeries help patients lose weight by constricting the stomach or intestines.

In this study, patients who underwent bariatric surgery before knee replacement were more likely to have improved quality of life. The added cost of bariatric surgery and delaying knee surgery was below the limit of what health insurance companies and the US government are typically willing to pay, Dr. McLawhorn and team found.

But that does not mean bariatric surgery is the right choice for every obese patient with knee osteoarthritis. Dr. McLawhorn noted that the pain may be too great for some patients to delay joint replacement surgery.

"Ideally, a team approach should be used to treat severely obese patients with knee arthritis in which various health care professionals are in place to help a patient lose weight, improve his or her health, and optimize nutrition before joint replacement to maximize its benefits," Dr. McLawhorn said. "The results of our study may help physicians when counseling patients and developing an individualized treatment plan that includes optimization of overall health, nutrition and weight prior to knee replacement."

These researchers noted that more in-depth research is needed on this topic.

This study was published Feb. 18 in the Journal of Bone and Joint Surgery.

The authors disclosed no outside funding sources. One or more authors disclosed ties that could be perceived to influence this research, according to this study.

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Review Date: 
February 21, 2016