Associations Between Weight Loss Prior to Knee and Hip Arthroplasty and Peri- and Post-Operative Outcomes: A Systematic Review and Meta-Analysis.

Abstract

In some of the existing literature, obesity is associated with increased complications in those who undergo lower limb arthroplasty. We conducted a systematic review and meta-analysis to assess if pre-arthroplasty weight loss mitigates increased post-operative risks. This systematic review and meta-analysis was registered on PROSPERO (CRD42023431110). Key terms were utilized to search PubMed, EMBASE, Ovid, Web of Science, Google Scholar, and Europe PMC. Peer-reviewed articles published between January 1, 2010, and December 31, 2024, were screened. Studies that reported specific outcomes (superficial wound infection, deep wound infection, pulmonary embolus [PE], deep vein thrombosis [DVT], and revision surgery) in an intervention group (patients with a BMI > 30 kg/m² who underwent pre-arthroplasty weight loss) and a control group (patients who underwent arthroplasty without preceding weight loss) 90 days post-arthroplasty were selected and data were extracted from studies meeting these inclusion criteria. Data were analyzed using a random effects model. Twenty-one articles were included in the meta-analysis. In people with obesity, pre-arthroplasty weight loss was associated with an increased risk of revision surgery in the first 90 days following lower limb arthroplasty (OR 1.37 [1.01-1.84], p = 0.04). Weight loss did not alter the risk of post-operative DVT, PE, superficial wound infections, and deep wound infections. Our results demonstrate that pre-arthroplasty weight loss does not improve short-term post-operative outcomes in people with obesity. Large, well-designed prospective studies should be performed to provide robust data for the development of evidence-based guidelines for lower limb arthroplasty in people living with obesity.