Five-Year Revision Surgery Rates After Total Ankle Arthroplasty and Ankle Arthrodesis in Patients With Prior Bariatric Surgery: A Retrospective Cohort Study.

Introduction: It is unclear how bariatric surgery for the treatment of obesity may affect outcomes of surgical treatment for ankle conditions. The purpose of this study was to compare rates of revision surgery after primary ankle arthrodesis ("arthrodesis") and total ankle arthroplasty ("arthroplasty") for patients who had undergone bariatric surgery and those who had not ("control group").

Methods: In this retrospective study, we used data from the PearlDiver database to compare 5-year revision surgery rates after arthroplasty and arthrodesis in patients with and without a history of bariatric surgery. Cohorts were propensity-matched by age, sex, and Charlson Comorbidity Index value in a 1:4 ratio. We explored the following surgical outcomes: arthroplasty revision, joint infection, instrumentation removal, open reduction and internal fixation (ORIF), and adjacent joint fusion. Cumulative incidence was calculated through Kaplan-Meier survival analysis and compared using Cox proportional hazard ratios.

Results: At 5 years after arthrodesis, the likelihood of adjacent joint fusion was higher among patients with a history of bariatric surgery than among control patients (hazard ratio: 1.8, 95% confidence interval, 1.2 to 2.6); however, we found no differences in surgical outcomes for joint infection, instrumentation removal, or ORIF. At 5 years after arthroplasty, surgical outcomes did not differ between those with a history of bariatric surgery versus control patients.

Discussion: These findings suggest that a history of bariatric surgery is not an important predictor of joint infection, instrumentation removal, or ORIF within 5 years after primary total ankle arthroplasty or arthrodesis. When choosing between arthroplasty or arthrodesis in patients who have undergone bariatric surgery, higher incidence of adjacent joint fusion should be a consideration.

Level of evidence: III, Retrospective cohort study.