Benefits of bariatric surgery before elective total joint arthroplasty: is there a role for weight loss optimization?

BACKGROUND: The association between obesity and osteoarthritis is well established, as is the increased risk of postoperative complications after total knee arthroplasty (TKA) and total hip arthroplasty (THA) among patients with obesity. OBJECTIVE: To evaluate the outcomes after TKA/THA based on whether the surgery was performed before or after bariatric surgery. SETTING: Integrated, multispecialty, community teaching hospital. METHODS: The medical records of all patients who underwent bariatric surgery from 2001 to 2014 were reviewed. Statistical analysis included χ2 test and t tests. A P value<.05 was considered significant. RESULTS: One-hundred and two patients were included; 36 had TKA/THA before their bariatric procedure, 66 underwent TKA/THA after their bariatric procedure. TKAs/THAs were performed at a mean of 4.9±3.2 years before and 4.3±3.3 years after bariatric surgery. Body mass index for those undergoing TKA/THA after bariatric surgery was lower than those with TKA/THA before bariatric surgery (37.6±7.4 versus 43.7±5.7 kg/m2; P<.001). Operative time and length of stay (LOS) were significantly decreased for TKA/THA performed after versus before bariatric surgery: 81.7±33.9 min versus 117±38.1 min; P<.001 and 2.9±0.7 versus 3.8±1.4 d; P<.001, respectively. Early complications and late reinterventions were similar. CONCLUSIONS: Decreased operative time and LOS were observed among patients who underwent TKA/THA after versus before their bariatric surgery. Patients who underwent TKA/THA after bariatric surgery had lower body mass index before and 1 year after TKA/THA. Postoperative complication rates were similar. Benefits of bariatric surgery and subsequent weight loss should be considered among patients with obesity requiring TKA/THA. Optimal timing of TKA/THA and bariatric surgery has yet to be established.

Revision shoulder arthroplasty with positive intraoperative cultures: the value of preoperative studies and intraoperative histology.

Currently, there are no reported results of patients without overt infection who had a positive intraoperative culture during revision shoulder arthroplasty. We therefore reviewed the intraoperative and preoperative investigations as well as the postoperative course of these patients who had positive intraoperative cultures. We reviewed the results of 75 shoulders without overt infection that underwent revision shoulder arthroplasty at our institution between January 1, 1974 and December 31, 2002 who had positive intraoperative cultures. Preoperatively, the results of 67 (93%) of 72 white-blood-cell counts were negative, 64 (91%) of 70 polymorphonuclear percentage distributions were negative, and 36 (86%) of 42 samples of erythrocyte sedimentation rate were negative. C-reactive protein concentration was measured in 16 patients, of which 12 (75%) had negative results. Results of intraoperative histologic evaluations were negative in 67 (92%) of 73 patients. The most common pathogen cultured was Propionibacterium acnes in 45 of 75, followed by Staphylococcus epidermidis in 10 of 75. Another operation was necessary in 10 (13%) of 75 shoulders to decrease pain or improve function. The mean time to re-revision was 2.5 years. The data from this study suggest that there are no good preoperative or intraoperative investigations to detect who will have a positive intraoperative culture at the time of revision shoulder arthroplasty.