Effect of non-surgical, non-pharmacological weight loss interventions in patients who are obese prior to hip and knee arthroplasty surgery: a rapid review

Sep 28, 2015Systematic reviews

Weight loss methods without surgery or drugs in obese patients before hip and knee replacement surgery

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Abstract

Of 263 articles identified, only four studies met inclusion criteria for examining weight loss prior to total joint arthroplasty.

Weight loss of ≥5% of body weight before total joint arthroplasty may be linked to a higher chance of deep surgical site infection in total hip arthroplasty patients.
In total knee arthroplasty patients, weight loss before surgery could be associated with increased 90-day readmission rates.
No significant differences in superficial surgical site infections were found between patients who lost weight pre-operatively and those who maintained their weight.
Limited data from randomized controlled trials suggest that dietician-supervised weight loss interventions may be effective before total joint arthroplasty.
Overall, there is limited evidence regarding the benefits of weight loss interventions on patient and surgical outcomes prior to total joint arthroplasty.

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BACKGROUND: Of the more than 104,000 Canadians who underwent elective total joint arthroplasty (TJA) surgery in 2012-2013 for hip and knee osteoarthritis (OA), 40 and 60 %, respectively, were obese. Obesity is associated with increased risks for receiving TJA, post-operative complications and delayed functional recovery. Current guidelines for patients with a body mass index (BMI) of ≥30 kg/m(2) are to participate in a weight management programme and to lose weight prior to TJA surgery. As part of a larger project, a rapid review was conducted to examine the effects of short-term non-pharmacological and non-surgical weight loss interventions in adults in the year prior to total hip arthroplasty (THA) and total knee arthroplasty (TKA) on surgical and patient outcomes, and adverse events.

METHODS: We performed a rapid review and searched seven electronic databases for English language articles published between 1990 and February 2015. Observational studies evaluating the association between pre-operative weight loss and short- and long-term outcomes, and controlled trials of non-pharmacological and non-surgical weight loss interventions were considered for inclusion. Two reviewers independently screened and selected articles, assessed methodological quality and extracted data.

RESULTS: Of 263 articles identified, a total of four studies met our inclusion criteria. In one of two high-quality retrospective cohort studies, weight loss ≥5 % of body weight in the year prior to TJA and maintained in the year after surgery was associated with a higher likelihood of deep surgical site infection in THA patients and 90-day readmission in TKA patients. No significant differences were reported in incidence of superficial surgical site infections in THA or TKA patients who lost weight pre-operatively compared to those who maintained their weight in either study. Two abstracts of randomized controlled trials were included; however, despite contacting the authors, full-length articles were not available. The limited information from the trials suggested that short-term dietician-supervised weight loss interventions were effective in weight loss prior to TJA.

CONCLUSIONS: There is limited evidence to support the recommendation of weight loss in the year prior to TJA and to determine the effectiveness of short-term non-pharmacological, non-surgical weight management interventions on patient and surgical outcomes.

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Effect of non-surgical, non-pharmacological weight loss interventions in patients who are obese prior to hip and knee arthroplasty surgery: a rapid review

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