The associations between bariatric surgery and hip or knee arthroplasty, and hip or knee osteoarthritis: Propensity score-matched cohort studies
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Date
2022-06
Publication Type
Journal Article
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yes
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Abstract
Objective
To investigate the associations between bariatric surgery and hip or knee arthroplasty, and secondary care hip or knee osteoarthritis (OA).
Methods
We performed cohort studies using data from Swedish nationwide healthcare registries. Patients aged 18–79 years who underwent bariatric surgery between 2006 and 2019 were matched on their propensity score (PS) to up to 2 obese patients (“unexposed episodes”) in risk-set sampling. After a 1-year run-in period, episodes were followed in an “as-treated” approach. Using Cox proportional hazard regression, we calculated hazard ratios (HR) with 95% confidence intervals (CIs) of hip or knee arthroplasty overall and in subgroups of age, sex, joint location, arthroplasty type, bariatric surgery type, and by duration of follow-up if proportional hazard assumptions were violated. In a secondary cohort, we assessed the outcome incident secondary care hip or knee osteoarthritis (OA).
Results
Among 39‘392 bariatric surgery episodes when compared to 61’085 PS-matched unexposed episodes (47′594 unique patients), the risk of hip or knee arthroplasty was strongest increased within the first three years of follow-up (HR 1.79, 95% CI 1.56–2.07), decreased thereafter, but remained elevated throughout follow-up. In a secondary cohort of 37′929 exposed when compared to 58′600 PS-matched unexposed episodes, the risk of hip or knee osteoarthritis was decreased (HR 0.84, 95% CI 0.79–0.90).
Conclusion
Bariatric surgery is associated with increased risks of hip or knee arthroplasty, but also with decreased risks of secondary care OA. This contradiction supports the hypothesis that bariatric surgery may act as an enabler for hip or knee arthroplasty.
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Publication status
published
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Book title
Journal / series
Volume
4 (2)
Pages / Article No.
100249
Publisher
Elsevier
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Edition / version
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Date collected
Date created
Subject
Bariatric surgery; Osteoarthritis; Arthroplasty; Obesity; Weight loss
Organisational unit
09633 - Burden, Andrea (ehemalig) / Burden, Andrea (former)
Notes
Funding
193622 - The risk of multiple elective surgeries following bariatric surgery: propensity score-matched cohort studies (SNF)