Total joint arthroplasty in patients surgically treated for morbid obesity

The results of 20 total hip and knee arthroplasties performed in patients w ith morbid obesity who were treated with bariatric surgery before arthropla sty are reviewed. Bariatric surgery was successful in reducing the Quetelet ratio (weight in kilogram divided by height in square meters) of patients from a mean of 49 kg/m(2) (range, 38-56 kg/m(2)) to a mean of 29 kg/m(2) (r ange, 25-32 kg/m(2)). The average time from bariatric surgery to arthroplas ty was 23 months (range, 7-65 months). The cumulative Knee Society score ha d improved significantly from a mean of 103.6 (range, 45-165) before arthro plasty to a mean of 148.9 (range, 66-185) at final follow-up in 12 knees un dergoing total knee arthroplasty (P <.01). The Harris hip score also had in creased significantly from a prearthroplasty mean of 40 (range, 25-55) to 6 7.5 (range, 50-95) at final follow-up in 8 hips receiving total hip arthrop lasties (P <.05). All but 1 patient with continuing patellofemoral pain wer e satisfied with the result of the arthroplasty at final follow-up. One hip was revised at 5 years for aseptic loosening of the femoral component; no knee revisions were required. All other prostheses were stable with no evid ence of radiographic loosening or wear at final surveillance. Morbidly obes e individuals, with severe degenerative joint disease, who are considered u nsuitable for arthroplasty because of excess weight should be considered fo r bariatric surgery. Total joint arthroplasty after surgical treatment of o besity has an excellent outcome with an acceptable complication rate.