While extensive literature has been published on the risks and benefits of bariatric surgery (BS) prior to and following lower-extremity arthroplasty, no similar investigations have been performed on the impact of BS prior to total shoulder arthroplasty (TSA).
The objective of the present study was to compare the incidence of mechanical complications in morbidly obese patients who undergo TSA: those who undergo BS following TSA compared with those who do not undergo BS, and those who undergo BS after TSA compared with those who undergo BS prior to TSA.
A Medicare database was queried for morbidly obese patients who underwent BS either before or after TSA, as well as those who underwent TSA but no BS. Of 12,277 morbidly obese patients who underwent TSA between 2005 and 2014, 304 underwent BS (165 of them prior to TSA and 139 following TSA) and 11,923 did not undergo BS. Rates of mechanical complications were then compared between groups using a logistic regression analysis.
Patients who underwent BS after TSA had significantly higher rates of mechanical complications (12.9%) compared to controls (8.8%) or patients who underwent prior BS (7.9%). Patients who underwent BS after TSA had higher rates of both instability (7.9%) and loosening (8.6%) than did controls (5.1 and 4.9%, respectively) or patients who underwent BS before TSA (4.8 and 4.2%, respectively).
BS following TSA is associated with increased rates of mechanical complications, including instability and loosening, compared to BS prior to TSA. These findings suggest that it may be prudent to consider performing BS prior to TSA in morbidly obese patients, rather than waiting until after TSA is performed.
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Conflict of Interest
J. M. Cancienne, MD, Christopher L. Camp, MD, B. C. Werner, MD, declare that they have no conflicts of interest. Stephen F. Brockmeier, MD, reports board or committee membership in American Orthopaedic Society for Sports Medicine, International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine, and MidAtlantic Shoulder and Elbow Society; editorial or governing board membership at Journal of Bone and Joint Surgery American, Orthopaedic Journal of Sports Medicine, Techniques in Shoulder and Elbow Surgery; research support and/or payment as presenter or speaker from Arthrex, Biomet, DePuy (A Johnson & Johnson Company), Tornier; publishing royalties or financial or material support from Springer; fees as a consultant from MicroAire Surgical Instruments LLC, Zimmer. Lawrence V. Gulotta, MD, reports receiving fees as a consultant and a presenter or speaker from Biomet and board membership at HSS Journal. David M. Dines, MD, reports board or committee membership in American Association of Orthopaedic Surgeons, American Shoulder and Elbow Surgeons; financial or material support from Biomet; publishing royalties from Saunders/Mosby-Elsevier; editorial or governing board membership from Springer; fees as a consultant from Wright Medical Technology, Inc.; intellectual property royalties from Zimmer.
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2013.
Informed consent was waived from all patients for being included in this study.
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Level of Evidence: Level III: Therapeutic Study
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Cancienne, J.M., Camp, C.L., Brockmeier, S.F. et al. Bariatric Surgery Following Total Shoulder Arthroplasty Increases the Risk for Mechanical Complications Including Instability and Prosthetic Loosening. HSS Jrnl 14, 108–113 (2018). https://doi.org/10.1007/s11420-017-9589-x
- Total shoulder arthroplasty
- bariatric surgery
- mechanical complication