How weight loss surgery could save patients money

Due for a joint replacement soon? Weight loss surgery first could save you money and improve the results of your joint replacement.
Two new studies found that weight loss surgery before joint replacement may be a cost-effective option that could help hip or knee surgery results.
Before these two studies, the effects of weight loss (or bariatric) surgery on joint replacement end results were not known.

“The researchers in these studies wished to evaluate whether or not bariatric surgery before total knee arthroplasty (TKA) is a good value by estimating the ratio of incremental cost to its incremental benefit,” said Adam C. Powell, PhD, a health care economist and president of Payer+Provider, in an interview with dailyRx News. “They found that it was what would be deemed a good value by many insurers. To make this estimate, they used a Markov Model — a mathematical model which examines transitions between states. These preliminary findings suggest that further research should be conducted on the benefits of promoting bariatric surgery before TKA.”
Emily Dodwell, MD, of the Hospital for Special Surgery in New York City, was the senior author for these studies.

“Up to 50 percent of hip replacements are performed in obese patients at some institutions,” Dr. Dodwell said in a press release. “Obesity is associated with longer hospital stays, higher overall costs and higher failure rates, necessitating costly revision surgery.”
Dr. Dodwell and team compared the costs of two treatment options for obese patients who had knee or hip osteoarthritis. Osteoarthritis is one of the most common forms of arthritis. It is a long-term condition in which the cartilage (cushioning around joints) wears down and causes bones to rub against each other. This results in stiffness, pain and joint movement loss.

One group of patients had joint replacements right away, without losing weight. The other group had weight loss surgery first. They then received a knee or hip replacement after two years. During the two-year waiting period, this group of patients lost weight.

“Our findings indicate that surgical weight loss prior to joint replacement is likely a cost-effective option from a public payer standpoint in order to improve outcomes in obese patients who are candidates for joint replacement,” Dr. Dodwell said.
Dr. Dodwell added, “Some health care systems do not include weight loss surgery as a covered benefit, and it is possible that studies such as this will be helpful in re-evaluating whether weight loss surgery may be a reasonable covered benefit.”

For those patients having severe knee or hip pain, holding off on joint replacement may not be wise, Dr. Dodwell and team noted. In that case, doctors and patients need to decide which has more priority — immediate pain relief or potentially better joint replacement outcomes in the long run.

“Ideally, a team approach would be used to treat morbidly obese patients with hip and knee arthritis in which various health care professionals are in place to help a patient lose weight, improve his or her health, and optimize nutrition before joint replacement to maximize its benefits,” said study author Alexander S. McLawhorn, MD, in a press release.
These studies were presented March 26 at the annual meeting of the American Academy of Orthopaedic Surgeons in Las Vegas.
Dr. Dodwell and team disclosed no funding sources or conflicts of interest.