Morbid Obesity and Severe Knee Osteoarthritis: Which Should Be Treated First?

作者：Stephanie Purcell, Intekhab Hossain, Bradley Evans, Geoff Porter, Glen Richardson, James Ellsmere · 发表于：Journal of Gastrointestinal Surgery · 年份：2022 · DOI：10.1007/s11605-022-05272-6 · 被引用次数：35 · 研究领域：Total Knee Arthroplasty Outcomes、Bariatric Surgery and Outcomes、Osteoarthritis Treatment and Mechanisms

BACKGROUND: There are limited prospective data, and conflicting retrospective data, providing guidance on how to optimally manage patients with morbid obesity and severe knee osteoarthritis. This study sought to review the effect of bariatric surgery on knee pain and knee surgery 30-day outcomes, as well as assess whether the sequence of bariatric and knee surgery has any effect on 30-day complications. METHODS: A retrospective chart review of all patients undergoing laparoscopic sleeve gastrectomy (LSG) from July 2006 to July 2016 at a university hospital was performed. Patients with knee pain or knee surgery (pre- or post-LSG) were identified using bariatric and orthopedic clinic notes. Those who had improvement in knee pain following LSG resulting in removal from orthopedic surgery waitlist were identified. We also assessed surgical outcomes in patients undergoing knee arthroscopy or total knee arthroplasty (TKA) followed by LSG compared to patients undergoing LSG followed by knee arthroscopy or TKA. RESULTS: During our study timeframe, 355 patients underwent LSG. Knee pain was documented in 150 (42.2%) patients, and orthopedic surgery consultation was completed for 57 (38.0%) patients with knee pain. Orthopedic intervention was performed prior to LSG for 24 patients and after LSG for 27 patients. Procedures were a combination of arthroscopy (18) and TKA (33). Six patients were removed from the waitlist for TKA following LSG due to resolution of symptoms. Order of interven...