No Difference in Revision Rates up to 10 years Following Total Hip Arthroplasty in Patients Who Had Prior Bariatric Surgery When Compared to Patients Who Had Class III Obesity: A Propensity Matched Analysis

Document Type

Journal Article

Publication Date



The Journal of arthroplasty




bariatric surgery; revision rates; total hip arthroplasty


INTRODUCTION: There is no clear research showcasing bariatric surgery's impact on long-term surgical complications following total hip arthroplasty (THA). Therefore, this study compared the 10-year cumulative incidence and risk of revision following THA in patients who underwent bariatric surgery when compared to the general population and class III obesity patients who did not undergo bariatric surgery. METHODS: Patients who underwent elective THA from 2010 to 2021 were identified using an all-payer claims database. Patients who underwent bariatric surgery prior to THA were separately matched to a control of the general population and those who had class III obesity (Body Mass Index (BMI) ≥ 40) by age, sex, Charlson Comorbidity Index (CCI), and diabetes using a 1:4 ratio. Kaplan-Meier analyses generated 10-year cumulative incidence rates, and a Cox proportional hazard ratio (HR) model generated hazard ratios and 95% confidence intervals (CI). RESULTS: When compared to the general control, patients who have a history of bariatric surgery had an elevated 10-year risk of all-cause revision (HR 1.31, 95% CI: 1.16 to 1.47, P < 0.001), prosthetic joint infection (HR: 1.62, CI: 1.30 to 2.04; P < 0.001), mechanical loosening (HR: 1.20, CI: 1.01 to 1.44; P = 0.040), and dislocation/instability (HR: 1.35, CI: 1.09 to 1.68; P = 0.007). There was no difference in the 10-year risk of all-cause revision or other indications for revision in the bariatric surgery cohort compared to the matched class III obesity cohort (P = 0.142). CONCLUSION: Those who underwent bariatric surgery before THA had comparable 10-year revision rates when compared to those who had class III obesity and higher rates compared to the general population. This suggests bariatric surgery may not reduce the 10-year surgical risks associated with obesity when compared to a class III obese surgical population.


Orthopaedic Surgery