SUN-790 Associations Between Weight Loss Pre-hip Or Pre-knee Arthroplasty And Peri- And Post-operative Outcomes

Abstract M. Gill: None. D. Llanera: None. T. Lindsay: None. T. Tan: None. A. Liddle: None. C. Izzi-Engbeaya: None. Obesity is positively associated with osteoarthritis and as such, represents an important modifiable risk factor. The incidence of osteoarthritis in those with obesity is increasing and arthroplasty plays a key role in improving mobility and quality of life. BMI thresholds are mandated by some commissioning bodies in the UK, leading to extended waiting times for arthroplasty. Obesity has been associated with increased pre- and post-operative complications after arthroplasty. It is not known if these risks can be mitigated by weight loss pre-operatively. This review explores the association between weight loss prior to hip or knee arthroplasty and peri- and post-operative outcomes. Methods: Our review was registered with PROSPERO and conducted using PRISMA guidelines. Key words were searched on Pubmed, EMBASE, Ovid, Web of Science, Google Scholar, Europe PMC and throughout grey literature. Peer-reviewed articles were screened by two independent reviewers. Studies evaluating those that underwent either medical or surgical weight loss prior to primary hip or knee arthroplasty were included. Exclusion criteria included: articles published before 2010, unavailable full texts, case studies/series, those assessing outcomes in upper limb arthroplasty, revision surgery and articles published in a language other than English. Outcome measures investigated included incidence of superficial wound infection, deep wound infection, pulmonary embolus, deep vein thrombosis (DVT) and revision surgery up to 90-days post-arthroplasty. The intervention group included patients who underwent pre-arthroplasty weight loss either through medical and/or surgical intervention. The control group were patients of any Body Mass Index (BMI) who underwent arthroplasty without intervention. Results In total 21 articles were included in the meta-analysis with data available for 50,672 patients in the intervention group and 1,446,755 patients in the control group. Pre-arthroplasty weight loss was- associated with an increased risk of revision surgery (Odds Ratio (OR) 1.32, 95% CI [1.13,1.53], p=0.0004) and DVT (OR 1.37, 95% CI [1.23 to 1.52], p=0.00001). However, there was no association between pre-arthroplasty weight loss and superficial wound infection (OR 1.08, 95% CI [0.84 to 1.40], p=0.54), deep wound infection (OR 0.97, 95% CI [0.77 to 1.22], p=0.79) or pulmonary embolism (OR 0.93, 95% CI [0.78 to 1.10], p=0.38). Conclusion: These data suggest that rapid weight loss prior to arthroplasty does not appear to reduce the risk of perioperative complications and may increase the risk of DVT and revision surgery. However, well-designed, and adequately powered prospective studies are required to establish the risks and benefits of pre-arthroplasty weight loss in people living with obesity. In addition, further research into the causative link between obesity and operative complications is also required. Sunday, June 2, 2024