Researchers at the New York Hospital for Special Surgery performed a computer-based evaluation of the effects of weight loss surgery before total knee replacement in morbidly obese people with end-stage osteoarthritis, and reported that the procedure could both improve outcomes and reduce the associated cost. The study is titled “Cost-Effectiveness of Bariatric Surgery Prior to Total Knee Arthroplasty in the Morbidly Obese.”
Obesity is associated with osteoarthritis, a condition where the cartilage at the end of the bones is worn down. Total knee replacement is a typical treatment for end-stage osteoarthritis, but previous studies have shown that the procedure in obese individuals is associated with a number of negative outcomes and, as a consequence, high costs.
Total knee replacement puts obese patients at risk for complications such as delayed wound healing, infection, the need for revision surgery, and lower functional outcomes.
The research team, led by Alexander McLawhorn, performed a computer-based model analysis of previously published data on cost and outcomes of total knee replacement and bariatric surgery, a collective term for weight loss surgery, in patients with morbid obesity and end-stage osteoarthritis. The model compared patients that underwent knee replacement without previous weight loss surgery to those that had knee replacement surgery performed two years after the weight-loss procedure.
The results, reported in the Journal of Bone and Joint Surgery, showed that weight loss surgery before knee replacement improved the quality of life, measured in quality-adjusted life years (QALYs), compared to patients undergoing total knee replacement without such prior surgery.
“We know that bariatric surgery can be an effective treatment for morbid obesity, reducing a patient’s excess weight. In addition, the surgery also reduces the burden of co-morbidities, like diabetes and high blood pressure, and may extend a patient’s life span. What we didn’t know was whether or not it is cost effective to recommend bariatric surgery to achieve weight loss and improve preoperative health prior to joint replacement,” Dr. McLawhorn said in a press release.
The associated cost for this level of improvement was $13,910 per QALY, an amount considered acceptable by healthcare insurers, whether private companies or the government.
“We found that successful bariatric surgery performed two years before total knee replacement could be a cost-effective treatment strategy for morbidly obese patients with end-stage arthritis,” Dr. McLawhorn added. “While there remains some uncertainty in terms of the precise effects of bariatric surgery on knee osteoarthritis and total knee replacement, our model summarizes what is known about the clinical effects and costs of obesity, bariatric surgery, and total knee replacement.”
“The results of this study may help surgeons in counseling morbidly obese patients with knee osteoarthritis, and trying to come up with an individualized treatment plan that includes optimization of overall health, nutrition, and weight prior to knee replacement,” he concluded.