The Arthroplasty and Bariatric Surgery (ABS) Study: a randomised controlled trial of laparoscopic adjustable gastric banding prior to total knee arthroplasty
Obesity is risk factor for orthopaedic surgery and also correlates with poorer early and longer term outcomes. TKA is a common orthopaedic procedure that carries a significantly higher risk of complication when performed on obese patients. This is important because the number of knee replacements undertaken in Australia has doubled over the last decade with 40,000 procedures performed in 2010. Australia is one of the leading nations in terms of obesity. 70% of patients presenting for TKA at our institution are obese and 1/3 are severely obese. Together these trends suggest that a significant cohort of patients in Australia are at risk of poor outcomes following TKA because of their body weight. As such there is compelling health and economic reasons to focus on weight reduction in severely obese patients prior to TKA. However, current lifestyle interventions do not result in sufficient sustained weight loss for severely obese patients with knee OA.
Laparascopic adjustable gastric banding (LAGB) is a relatively safe, procedure that has been proven to be an effective form of inducing significant and sustained weight loss in the general obese population. To date, no research has evaluated whether LAGB will provide significant weight loss in severely obese patients with end stage osteoarthritis (OA) awaiting total knee arthroplasty (TKA) and whether this results in improved outcomes following surgery.
We are undertaking a 4 year multi-institutional RCT in severely obese patients with end stage OA. We plan to measure weight loss and outcomes as well as the cost effectiveness of a strategy that combines TKA+LAGB, compared to TKA alone.
This study is the first of its kind, and will provide valuable clinical and procedural information for developing strategies for treating severely obese patients undergoing TKA and may have an additional impact on other high volume elective procedures.
- Prof Wendy Brown (CI-B), Centre for Obesity Research and Education, Monash University
- Prof Danny Liew (CI-C), Department of Epidemiology and Preventive Medicine, Monash University
- Prof Paul Obrien (AI) Centre for Obesity Research and Education, Monash University