Impact of bariatric surgery on total knee arthroplasty


  • Awath F. Mohamed King Abdulaziz Hospital, Jeddah, Saudi Arabia
  • Ahmed A. Juwaiber Alnoor Specialist Hospital, Makkah, Saudi Arabia



Bariatric surgery, Obesity, Total knee arthroplasty, Post-operative complications, BMI


Obesity is a key risk factor for the development of knee osteoarthritis, and the incidence of obesity has more than quadrupled in the last 30 years. Total knee arthroplasty is used to treat severe knee osteoarthritis, and the need for initial total knee arthroplasties is predicted to expand rapidly. Total knee arthroplasty, on the other hand, is related with increased problems, longer hospital stays, and higher expenditures in obese individuals. The purpose of this study was to see if bariatric surgery affected knee symptoms in obese (BMI >30 kg/m2) adult patients. The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, TRIP, BIOSIS-Previews, and reference lists of retrieved articles were thoroughly searched in English from the earliest available up to 30 December 2022 They included studies with a minimum follow-up of 4 months on the effect of surgically induced weight loss on knee symptoms in obese adult patients. Excluded were research investigating the impact of lipectomy or liposuction, as well as trials in which patients had already undergone total knee arthroplasty. This systematic review comprised 127 studies with a total of 22,229 patients. Despite the fact that several evaluation measures were utilized, an overall substantial reduction in knee pain was observed in 76% of the assessments. After bariatric surgery, all trials assessing the level of knee pain, physical function, and stiffness revealed a considerable improvement. For the majority of the included research, the quality of the evidence was extremely poor or very low, while it was moderate for one study. In obese adult patients, bariatric surgery followed by significant weight reduction is likely to improve knee pain, physical function, and stiffness. However, considering the existing data, high-quality research is required.


Katz JN, Arant KR, Loeser RF. Diagnosis and treatment of hip and knee osteoarthritis: a review. JAMA. 2021;325(6):568-78.

Mohajan D, Mohajan HK. Obesity and Its Related Diseases: A New Escalating Alarming in Global Health. J Innov Med Res. 2023;2(3):12-23.

Bray GA, Kim KK, Wilding JP, World Obesity Federation. Obesity: a chronic relapsing progressive disease process. A position statement of the World Obesity Federation. Obesity Rev. 2017;18(7):715-23.

Liabaud B, Patrick Jr DA, Geller JA. Higher body mass index leads to longer operative time in total knee arthroplasty. J Arthroplasty. 2013;28(4):563-5.

Madsen AA, Taylor BC, Dimitris C, Hansen DC, Steensen RA, Gaines ST. Safety of bilateral total knee arthroplasty in morbidly obese patients. Orthopedics. 2014;37(3):e252-9.

Deledda A, Pintus S, Loviselli A, Fosci M, Fantola G, Velluzzi F. Nutritional management in bariatric surgery patients. Int J Env Res Public Health. 2021;18(22):12049.

Seward MW, Briggs LG, Bain PA, Chen AF. Preoperative nonsurgical weight loss interventions before total hip and knee arthroplasty: a systematic review. J Arthroplasty. 2021;36(11):3796-806.

Yan M, Zheng G, Long Z, Pan Q, Wang X, Li Y, Lei C. Does bariatric surgery really benefit patients before total knee arthroplasty? A systematic review and meta-analysis. Int J Surg. 2022;106778.

Herrera PA, Campos-Romero S, Szabo W, Martínez P, Guajardo V, Rojas G. Understanding the relationship between depression and chronic diseases such as diabetes and hypertension: A grounded theory study. Int J Env Res Public Health. 2021;18(22):12130.

Haddad A, Kow L, Herrera MF, Cohen RV, Himpens J, Greve JW, Shikora S. Innovative bariatric procedures and ethics in bariatric surgery: the IFSO position statement. Obesity Surg. 2022;32(10):3217-30.

Haddad A, Kow L, Herrera MF, Cohen RV, Himpens J, Greve JW, Shikora S. Innovative bariatric procedures and ethics in bariatric surgery: the IFSO position statement. Obesity Surg. 2022;32(10):3217-30.

Vervullens S, Meert L, Baert I, Smeets RJ, Verdonk P, Rahusen F, Meeus M. Prehabilitation before total knee arthroplasty: A systematic review on the use and efficacy of stratified care. Ann Phys Rehab Med. 2023;66(4):101705.

Cordero JK, Lawrence KW, Brown A, Li X, Hayden BL, Parisien RL. The Fragility of Tourniquet Use in Total Knee Arthroplasty: A Systematic Review of Randomized Controlled Trials. J Arthroplasty. 2022;22.

Rouleau G, Hong QN, Kaur N, Gagnon MP, Côté J, Bouix-Picasso J, Pluye P. Systematic reviews of systematic quantitative, qualitative, and mixed studies reviews in healthcare research: how to assess the methodological quality of included reviews? J Mixed Methods Res. 2023;15586898211054243.

McMahon A, Rao SS, Chaudhry YP, Hasan SA, Epstein JA, Hegde V, Valaik DJ, Oni JK, Sterling RS, Khanuja HS. Preoperative patient optimization in total joint arthroplasty—The paradigm shift from preoperative clearance: A narrative review. HSS Journal®. 2022;18(3):418-27.

Narendra K, Kiss N, Margerison C, Johnston B, Chapman B. Impact of nutritional status/risk and post‐operative nutritional management on clinical outcomes in patients undergoing gastrointestinal surgery: a prospective observational study. J Human Nutrition Dietetics. 2020 33(4):587-97.

Lawrence BJ, Kerr D, Pollard CM, Theophilus M, Alexander E, Haywood D, O’Connor M. Weight bias among health care professionals: a systematic review and meta‐analysis. Obesity. 2021;29(11):1802-12.

Adebibe M, Coppack SW. Obesity-Associated Comorbidities: Health Consequences. Obesity, Bariatric and Metabolic Surgery: A Comprehensive Guide. 2023;47.

Zaminpeyma R, Claus M, Paraskevas S, Court O, Tchervenkov J, Andalib A. Outcomes of kidney transplant recipients who underwent pre-transplant bariatric surgery for severe obesity: a long-term follow-up study. Surgical Endoscopy. 2023;37(1):494-502.

Smith NA, Martin G, Marginson B. Preoperative assessment and prehabilitation in patients with obesity undergoing non-bariatric surgery: A systematic review. J Clin Anesth. 2022;78:110676.






Systematic Reviews