Patients › General-Health
Peso, obesidad y salud articular
How body weight and obesity affect joint load, osteoarthritis, and the risks and outcomes of joint surgery — including the role of weight loss before an operation.
¿Qué es?¶
El peso y la salud articular están estrechamente relacionados. El exceso de peso afecta a más que solo a las rodillas. La obesidad es una condición que afecta a todo el cuerpo y provoca inflamación; esa inflamación también llega a las articulaciones [1]. No se trata únicamente de la carga adicional que soportan las articulaciones a diario.
Un índice de masa corporal elevado aumenta el riesgo de artrosis (osteoartritis) en las rodillas y las manos, incluso en personas por lo demás sanas [2]. La grasa acumulada en la zona abdominal (obesidad central) también está vinculada a la artritis en la articulación del hombro [3]. Si está considerando someterse a una cirugía articular, el peso será uno de los temas que su médico abordará con usted.
La interacción entre el peso y la actividad física no es bien comprendida por muchas personas. Se ha prestado mucha más atención a la dieta que a la falta de actividad física como causa de la obesidad [4]. El movimiento es importante: mantenerse en forma protege el corazón y la salud general, y atenúa algunos de los riesgos derivados del exceso de peso [5]. Incluso pequeñas cantidades de actividad física intensa, alrededor de 30 a 35 minutos por semana, parecen contrarrestar la relación entre la obesidad abdominal y las enfermedades cardíacas [6].
El peso es algo que usted puede modificar. Combatir la obesidad puede mejorar la salud articular y la salud general, incluso en niños [7]. Si se está preparando para una cirugía de reemplazo articular, controlar el peso y otras condiciones de salud previamente puede permitir obtener resultados similares a los de pacientes con un índice de masa corporal normal [8].
¿Funciona realmente?¶
La respuesta honesta es que depende de a qué nos refiramos con “ello”. En cuanto a la pérdida de peso en sí, la cirugía resulta más eficaz que ir directamente a un reemplazo de rodilla cuando una persona padece obesidad severa y artritis avanzada. En un estudio, quienes se sometieron a cirugía para perder peso redujeron su peso corporal en un 28,7 %, mientras que quienes optaron directamente por el reemplazo de rodilla perdieron menos [1]. Los fármacos más recientes para la pérdida de peso constituyen otra alternativa. Un estudio demostró que un medicamento llamado semaglutida era una opción segura en lugar de la cirugía para perder peso antes de un reemplazo de cadera, con tasas similares de supervivencia del implante y de complicaciones [2].
En lo que respecta a la cirugía de reemplazo articular en sí, la situación es más variada de lo que muchas personas imaginan. Tener un IMC elevado no implica automáticamente peores resultados. Diversos estudios han demostrado que un IMC superior a 40 no se asocia con complicaciones tempranas tras el reemplazo de rodilla, siempre que se controlen previamente otras afecciones médicas y se planifique la intervención de forma individualizada para el paciente [3]. En estudios sobre reemplazo de cadera, se constató que el grado de obesidad no influye en el riesgo, el nivel de invasividad ni el momento de futuras operaciones [4]. En estudios sobre reemplazo de hombro, el IMC tampoco se relacionó con un mayor riesgo de necesitar cirugía de revisión [5]. No obstante, otros estudios sí señalan mayores riesgos: las personas obesas sometidas a cirugía artroscópica de cadera tienen más del doble de probabilidades de precisar posteriormente un reemplazo total de cadera, en comparación con personas de peso normal [6]. La obesidad también incrementa el riesgo de necesitar cirugía de revisión tras un reemplazo parcial de rodilla [7].
Algunas de estas evidencias son sólidas, mientras que otras no lo son tanto. Algunos de estos hallazgos provienen de estudios de tamaño reducido, por lo que sus resultados son menos fiables. Por ejemplo, un estudio sugirió que un IMC de 45 constituía un límite seguro para cierto tipo de reemplazo de rodilla; sin embargo, los grupos analizados eran demasiado pequeños para afirmarlo con certeza [8]. El ejercicio también puede ser de gran ayuda: mujeres con baja masa muscular y obesidad que practicaron entrenamiento intervalado de alta intensidad perdieron más peso y presentaron un IMC más bajo que quienes realizaron ejercicio moderado y continuo [9]. La combinación de ejercicio y fármacos para la pérdida de peso también puede favorecer una mejor salud a largo plazo y ayudar a mantener el peso bajo control [10].
¿Cuáles son los riesgos?¶
Los riesgos dependen del tipo de operación que se vaya a realizar. En el caso del reemplazo de rodilla, los métodos quirúrgicos modernos y los diseños de prótesis parecen haber reducido los problemas previos de aflojamiento y falla mecánica en personas con obesidad [1]. No obstante, algunos riesgos persisten. La obesidad sigue siendo un factor de riesgo importante para la falla mecánica en ciertos tipos de prótesis de rodilla robóticas, aunque la funcionalidad diaria posterior fue similar [2]. Las personas con obesidad severa (IMC de 35 o más) mostraron una tendencia a presentar más complicaciones tras el reemplazo de rodilla robótico, aunque dicha diferencia no fue concluyente [3]. Si se realiza un reemplazo parcial de rodilla en lugar de uno total, la obesidad aumenta la probabilidad de necesitar una cirugía de revisión [4].
En cuanto a la cirugía de cadera y hombro, la situación es más estable. Tras el reemplazo de cadera, el grado de obesidad no influye en el riesgo, el grado de invasividad ni el momento de futuras intervenciones [5]. El hecho de padecer diabetes tipo 2 además de obesidad no incrementa el riesgo de reoperación, una vez que se tiene en cuenta el IMC [6]. Después del reemplazo de hombro, el IMC no se relaciona con un mayor riesgo de cirugía de revisión [7]; sin embargo, el sobrepeso y la obesidad sí se asocian con mayor riesgo de formación de coágulos sanguíneos, no de infecciones [8].
La cirugía mínimamente invasiva conlleva otros riesgos. Si se realiza una cirugía de cadera mínimamente invasiva para tratar un conflicto femoroacetabular doloroso, la obesidad duplica o más la probabilidad de que posteriormente se necesite un reemplazo total de cadera [9]. Tanto la obesidad como la artritis preexistente predicen peores resultados tras una cirugía de rodilla mínimamente invasiva [10]. Tras una reparación de la raíz meniscal, la artritis avanza más rápidamente en personas con mayor IMC [11].
Algunos hallazgos son menos concluyentes. Un estudio sugirió que un IMC de 45 sería un límite seguro para cierto tipo de prótesis de rodilla; sin embargo, los grupos estudiados eran demasiado pequeños para confirmarlo [12]. La evidencia respecto a la necesidad de reforzar la prótesis en pacientes obesos durante el reemplazo de rodilla es limitada e inconsistente [13]. La cicatrización de heridas depende más del grosor del tejido blando sobre el hueso que del IMC por sí solo [14].
Muy pocas personas con obesidad reciben tratamiento para perder peso antes del reemplazo articular, ya sea mediante medicamentos, servicios nutricionales o cirugía bariátrica [15]. Si el peso corporal es motivo de preocupación, vale la pena comentarlo con su médico con antelación.
¿Es adecuado para usted?¶
El reemplazo articular puede ser una buena opción para personas con un IMC más elevado. Estudios han demostrado que un IMC superior a 40 no se asocia a complicaciones tempranas tras el reemplazo de rodilla [1]. En estudios sobre reemplazo de cadera, se observó que el grado de obesidad no influye en el riesgo, el grado de invasividad ni el momento en que se requieren intervenciones adicionales [2]. Asimismo, en estudios sobre reemplazo de hombro, el IMC no se relaciona con una mayor probabilidad de necesitar cirugía de revisión [3]. Por lo tanto, el sobrepeso por sí solo no excluye a una persona como candidata para la cirugía.
No obstante, existen límites. Un estudio sugirió que un IMC de 45 sería un umbral seguro para cierto tipo de reemplazo de rodilla; sin embargo, los grupos estudiados eran demasiado pequeños para confirmarlo [4]. Si está considerando una cirugía artroscópica de cadera en lugar del reemplazo, la obesidad duplica o más la probabilidad de que posteriormente necesite un reemplazo total de cadera [5]. Otra alternativa es perder peso antes de la cirugía; fármacos recientes como la semaglutida han sido estudiados como opción segura frente a la cirugía bariátrica previa al reemplazo de cadera [6]. No obstante, muy pocas personas con obesidad reciben tratamiento para perder peso antes del reemplazo articular, ya sea mediante medicamentos, asesoramiento nutricional o cirugía bariátrica [7].
La elección adecuada depende de su peso, del grado de artritis y de sus demás condiciones de salud. En la sección de riesgos anterior se detallan las posibles complicaciones de cada opción. Hable al respecto con su médico: se trata de una decisión compartida, tomada conjuntamente.
Conclusión¶
El exceso de peso no impide someterse a una cirugía articular, pero sí modifica el panorama clínico. En los reemplazos de rodilla y cadera, un IMC elevado por sí solo no se asoció a más complicaciones tempranas, siempre que se controlaran previamente otras afecciones de salud [1]. La principal advertencia se refiere a la cirugía artroscópica: la obesidad duplica con creces la probabilidad de que posteriormente sea necesario realizar un reemplazo total de cadera [2]. Perder peso antes de la cirugía es una opción que merece ser discutida, aunque en la práctica muy pocas personas reciben esta recomendación [3].
Referencias¶
[1] Replanteamiento de la obesidad en la artrosis de rodilla: un llamado a un enfoque transdisciplinario más allá de la biomecánica. Arthroscopy. 2026. DOI: 10.1002/arj.70051
[2] ¿Aumenta la obesidad metabolíticamente saludable el riesgo de artrosis de rodilla y mano? Un estudio de cohorte basado en la población. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-026-09495-5
[3] Asociación entre la obesidad central y el riesgo de artrosis de la articulación glenohumeral: un estudio prospectivo. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2025.07.007
[4] Es hora de desmontar el mito de la inactividad física y la obesidad: no se puede “correr” más que una mala alimentación. British Journal of Sports Medicine. 2015. DOI: 10.1136/bjsports-2015-094911
[5] Condición cardiorrespiratoria, índice de masa corporal y mortalidad: una revisión sistemática y metaanálisis. British Journal of Sports Medicine. 2024. DOI: 10.1136/bjsports-2024-108748
[6] Asociaciones conjuntas entre la actividad física medida mediante dispositivos y la obesidad abdominal con la aparición de enfermedades cardiovasculares: un estudio de cohorte prospectivo. British Journal of Sports Medicine. 2023. DOI: 10.1136/bjsports-2023-107252
[7] El papel de la obesidad en la ortopedia pediátrica. JAAOS: Global Research and Reviews. 2019. DOI: 10.5435/jaaosglobal-d-19-00036
[8] Un índice de masa corporal > 40 no se correlaciona con complicaciones tempranas en pacientes sometidos a artroplastia total primaria en un centro quirúrgico ambulatorio. The Journal of Arthroplasty. 2026. DOI: 10.1016/j.arth.2025.08.065
[9] Impacto de la cirugía bariátrica previa frente a la artroplastia total de rodilla inmediata en la función de la rodilla en pacientes con obesidad severa y artrosis avanzada de rodilla: el ensayo SWIFT. The Journal of Arthroplasty. 2026. DOI: 10.1016/j.arth.2026.05.033
[10] ¿Es la semaglutida una opción más segura para el control de peso que la cirugía bariátrica en pacientes sometidos a artroplastia total de cadera (THA)? The Journal of Arthroplasty. 2026. DOI: 10.1016/j.arth.2025.08.068
[11] El grado de obesidad no se asocia con la incidencia, el momento ni el grado de invasividad de las reoperaciones tras la artroplastia total de cadera. The Journal of Arthroplasty. 2026. DOI: 10.1016/j.arth.2025.07.026
[12] Tasas de revisión entre pacientes obesos y no obesos sometidos a artroplastia total de hombro: un estudio con datos del registro australiano. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2025.05.036
[13] Pacientes obesos tratados con artroscopia de cadera por síndrome de impacto femoroacetabular: resultados funcionales a 10 años y tasas de conversión a artroplastia comparadas con pacientes de peso normal. The American Journal of Sports Medicine. 2026. DOI: 10.1177/03635465251392585
[14] La obesidad se asocia con tasas más altas de revisión tras la artroplastia unicompartimental de rodilla. Orthopaedic Journal of Sports Medicine. 2026. DOI: 10.1177/2325967125s00336
[15] Un índice de masa corporal de 45 es un umbral seguro para la artroplastia total de rodilla sin cemento. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2025.12.038
[16] Impacto del entrenamiento intervalado de alta intensidad frente al entrenamiento continuo de intensidad moderada combinado con entrenamiento de fuerza en los resultados físicos y metabólicos en pacientes poscirugía bariátrica con obesidad sarcopénica. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-026-09722-z
[17] El ejercicio en el mantenimiento de la pérdida de peso: beneficios para la salud más allá de la reducción del peso en la báscula. British Journal of Sports Medicine. 2021. DOI: 10.1136/bjsports-2021-104754
[18] La obesidad y la artroplastia total de rodilla revisitada: mínimo impacto en el aflojamiento y el fallo mecánico en la era moderna. The Journal of Arthroplasty. 2026. DOI: 10.1016/j.arth.2026.04.031
[19] Impacto de un alto índice de masa corporal en la artroplastia total de rodilla robótica basada en imágenes y alineación funcional: resultados funcionales comparables, pero mayor incidencia de fallos mecánicos. Journal of ISAKOS. 2025. DOI: 10.1016/j.jisako.2025.100861
[20] Efecto del índice de masa corporal sobre los resultados de la artroplastia total de rodilla asistida por robot: Análisis retrospectivo de una cohorte. Journal of ISAKOS. 2025. DOI: 10.1016/j.jisako.2025.100927
[21] La diabetes tipo 2 no se asocia con un riesgo elevado de infección periprotésica en pacientes obesos sometidos a artroplastia total de cadera. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-026-09568-5
[22] El sobrepeso y la obesidad premórbida se correlacionan con un mayor riesgo de tromboembolismo, pero no de infección, tras la artroplastia total de hombro. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2026.05.022
[23] Comentario editorial:
[24] La reparación de desgarros en la raíz posterior del menisco medial muestra progresión de la artrosis con el tiempo; este fenómeno es más frecuente en pacientes con mayor índice de masa corporal. Arthroscopy. 2026. DOI: 10.1002/arj.70028
[25] Respuesta a: “Carta al editor comentando sobre: ‘La evidencia actual no respalda el uso de extensión de tallo tibial en la artroplastia total de rodilla en pacientes obesos: una revisión sistemática’”. The Journal of Arthroplasty. 2026. DOI: 10.1016/j.arth.2025.11.056
[26] La relación tejido blando/hueso es un mejor predictor de infección periprotésica en la artroplastia total de rodilla que el índice de masa corporal: Estudio retrospectivo de casos y controles. The Journal of Arthroplasty. 2026. DOI: 10.1016/j.arth.2025.09.022
[27] Disparidades en la pérdida de peso preoperatoria y en el tratamiento de la obesidad antes de la artroplastia total de articulaciones. The Journal of Arthroplasty. 2026. DOI: 10.1016/j.arth.2026.06.021
Evidence & references
This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.
Overview¶
- Obesity is a modifiable condition, and addressing it can improve the orthopaedic and overall health of children [1].
- Each 1-unit increase in body mass index (BMI) is associated with a 9% reduction in osteoporosis risk [2].
- There is significant confusion regarding the relationship between energy intake, energy expenditure, and obesity, with greater attention focused on diet than on physical inactivity [3].
- Obesity is a systemic disease with profound inflammatory consequences on joint health, extending beyond mechanical burden on the knee [5].
- Current evidence does not support the routine use of tibial stem extensions in obese total knee arthroplasty patients due to insufficient, heterogeneous, and very low certainty data [7].
- Increasing obesity severity is not associated with higher rates of postoperative stiffness or inferior outcomes following manipulation under anesthesia (MUA) [10].
- Concern for stiffness alone should not serve as a categorical barrier to total knee arthroplasty (TKA) or MUA when clinically indicated [10].
- In a cohort of obese patients who underwent total hip arthroplasty (THA), the World Health Organization (WHO) obesity class was not associated with the risk, invasiveness, or timing of reoperations [15].
- Obese and overweight patients converted to total hip arthroplasty (THA) at significantly higher rates compared with normal-weight patients following hip arthroscopy for femoroacetabular impingement syndrome [16].
- The ten-year functional outcomes and revision rates of total hip arthroplasty (THA) do not justify restricting access to surgery on the basis of body mass index (BMI) [28].
How It Works¶
Systemic and Metabolic Mechanisms¶
- Obesity is a systemic disease with profound inflammatory consequences on joint health [5].
- Each 1-unit increase in BMI is associated with a 9% reduction in osteoporosis risk [2].
- There is confusion regarding the relation of energy intake and energy expenditure to obesity, with more attention focused on diet than on physical inactivity [3].
Biomechanical and Structural Factors¶
- Following medial meniscus posterior root tear repair, osteoarthritis progression occurs at higher rates with elevated BMI [20].
- Obesity remains a critical risk factor for mechanical failures in functionally aligned image-based robotic total knee arthroplasty [14].
- Modern surgical practices and implant designs may have mitigated traditional obesity-related risks regarding loosening and mechanical failure in total knee arthroplasty [11].
Surgical Outcomes and Complications¶
- In patients undergoing primary total joint arthroplasty at an ambulatory surgical center, a BMI > 40 is not correlated with early complications [6].
- Focusing on management of preoperative comorbidities and custom surgical planning can achieve outcomes comparable to those of patients with normal BMIs at ambulatory surgical centers [6].
- Increasing obesity severity is not associated with higher rates of postoperative stiffness or inferior outcomes following manipulation under anesthesia for total knee arthroplasty [10].
- No significant differences were observed between above-average and below-average BMI groups in clinical improvements following arthroscopically assisted posterior latissimus dorsi tendon transfer for irreparable posterosuperior rotator cuff tears [9].
- A nonsignificant trend toward a higher complication rate was observed in patients with severe obesity (BMI ≥35 kg/m2) undergoing robotic-assisted total knee arthroplasty [22].
- A statistically significant increase in arthrofibrosis was found in patients with BMI <25 kg/m2 undergoing robotic-assisted total knee arthroplasty [22].
- The numbers were too small to draw conclusions in patients who have a BMI ≥ 45 undergoing cementless total knee arthroplasty [4].
Risk Stratification and Measurement¶
- Body mass index has a weak-to-moderate association with peri-incisional adiposity in primary total joint arthroplasty patients [21].
- The soft tissue-to-bone ratio reflects local anatomical factors that directly influence surgical exposure and wound healing, unlike BMI [19].
Modifiability and Intervention¶
- Obesity is modifiable, and addressing the issue can improve the orthopaedic and overall health of children [1].
- Physical activity equivalent to approximately 30–35 min of vigorous intensity per week appears to offset the association between abdominal obesity and incident cardiovascular disease [8].
- When combined with liraglutide treatment, exercise results in a more holistic state of health that may result in improved longer-term health and may enhance adherence to the treatment and promote longer-term weight-loss maintenance [12].
- An aggregate exercise programme energy expenditure (>10 000 kcal) may be required to promote reductions in intrahepatic fat [13].
What the Evidence Shows¶
Systemic and Metabolic Associations¶
- Obesity is a systemic disease with profound inflammatory consequences on joint health, extending beyond mechanical burden [5].
- An aggregate exercise programme energy expenditure greater than 10,000 kcal may be required to promote reductions in intrahepatic fat in adults who are overweight or exhibit fatty liver disease [13].
- Physical activity equivalent to approximately 30–35 minutes of vigorous intensity per week appears to offset the association between abdominal obesity and incident cardiovascular disease [8].
Pediatric and General Health¶
Preoperative Weight Management¶
- Semaglutide appears to be a safe alternative to bariatric surgery for weight management before total hip arthroplasty, with similar implant survival and postoperative complication rates [17].
- In patients with severe obesity and advanced knee osteoarthritis, total weight loss percentage was higher in bariatric surgery patients (28.7%) compared to those undergoing immediate total knee arthroplasty [26].
- Women had decreased odds of losing greater than five pounds before surgery despite increased odds of having preoperative bariatric surgery [18].
- Women with high-intensity interval training had significant reduction in their weight and BMI compared to those who followed a moderate-intensity continuous training protocol [27].
Knee Arthroplasty¶
- Current evidence does not support the routine use of tibial stem extensions in obese total knee arthroplasty patients due to insufficient, heterogeneous, and very low certainty data, though specific designs may benefit selected populations [7].
- Obesity remains a critical risk factor for mechanical failures in functionally aligned image-based robotic total knee arthroplasty, despite comparable functional outcomes [14].
- Obese patients are at increased risk of a higher rate of revision following unicompartmental knee arthroplasty [31].
- The numbers of patients with a BMI ≥ 45 were too small to draw conclusions regarding the safety of cementless total knee arthroplasty in that specific group [4].
Hip Arthroplasty¶
- In morbidly obese patients, dual mobility implants demonstrated excellent five-year survivorship with outcomes comparable or slightly superior to fixed-bearing constructs [24].
Hip Arthroscopy and Rotator Cuff¶
- Obese and overweight patients converted to total hip arthroplasty at significantly higher rates compared with normal-weight patients following hip arthroscopy for femoroacetabular impingement syndrome [16].
- Hip arthroscopy for the treatment of femoroacetabular impingement and labral tears in patients with obesity yielded significant and sustainable long-term improvements, which were equivalent to those of a benchmark matched control group of normal-weight patients [25].
- No significant differences were observed between above-average and below-average BMI groups, and BMI was not correlated with clinical improvements following arthroscopically assisted posterior latissimus dorsi tendon transfer for irreparable posterosuperior rotator cuff tears [9].
Practical Considerations¶
Pediatric and Systemic Health¶
- There is significant confusion regarding the relationship between energy intake, energy expenditure, and obesity, with greater attention historically focused on diet than on physical inactivity [3].
Bone Density and Cardiovascular Risk¶
- Each 1-unit increase in body mass index is associated with a 9% reduction in osteoporosis risk [2].
Total Knee Arthroplasty¶
- A body mass index of 45 is identified as a safe cut-off for cementless total knee arthroplasty, though sample sizes were too small to draw conclusions for patients with a BMI ≥ 45 [4].
- Body mass index greater than 40 is not correlated with early complications in patients undergoing primary total joint arthroplasty at an ambulatory surgical center [6].
- Focusing on the management of preoperative comorbidities and custom surgical planning can achieve outcomes comparable to those of patients with normal BMIs at ambulatory surgical centers [6].
- Specific tibial stem extension designs may benefit selected populations of obese total knee arthroplasty patients [7].
- Increasing obesity severity is not associated with higher rates of postoperative stiffness or inferior outcomes following manipulation under anesthesia [10].
- Concern for stiffness alone should not serve as a categorical barrier to total knee arthroplasty or manipulation under anesthesia when clinically indicated [10].
Total Hip Arthroplasty¶
- The World Health Organization obesity class is not associated with the risk, invasiveness, or timing of reoperations after total hip arthroplasty in obese patients [15].
Shoulder and Rotator Cuff¶
- Body mass index does not affect clinical outcomes following arthroscopically assisted posterior latissimus dorsi tendon transfer for irreparable posterosuperior rotator cuff tears [9].
- No significant differences were observed between above-average and below-average BMI groups regarding clinical improvements in arthroscopically assisted posterior latissimus dorsi tendon transfer [9].
- Obesity is associated with an increased risk of all-cause revisions in patients receiving reverse total shoulder arthroplasty indicated for fractures [23].
- Obesity is associated with an increased risk of revision for instability or dislocation in patients receiving reverse total shoulder arthroplasty indicated for fractures [23].
Key Evidence¶
- [L5] Obesity is modifiable, and addressing the issue can improve the orthopaedic and overall health of children. [1] (10.5435/jaaosglobal-d-19-00036)
- [L1] Based on our dose–response analysis of nine studies, each 1-unit increase in BMI was associated with a 9% reduction in osteoporosis risk. [2] (10.1186/s12891-026-09675-3)
- [L5] There is enormous confusion about the relation of energy intake and energy expenditure to obesity, with much more attention focused on diet and obesity than on physical inactivity and obesity. [3] (10.1136/bjsports-2015-094911)
- [L3] However, the numbers were too small to draw conclusions in patients who have a BMI ≥ 45. [4] (10.1016/j.arth.2025.12.038)
- [L5] Obesity is more than a mechanical burden on the knee; it is a systemic disease with profound inflammatory consequences on joint health. [5] (10.1002/arj.70051)
- [L3] Focusing on management of preoperative comorbidities and custom surgical planning can achieve outcomes comparable to those of patients who have normal BMIs at ASCs, questioning BMI as an exclusion criterion and advocating for more inclusive, evidence-based patient selection. [6] (10.1016/j.arth.2025.08.065)
- [L5] The authors conclude that current evidence does not support the routine use of tibial stem extensions in obese total knee arthroplasty patients due to insufficient, heterogeneous, and very low certainty data, though specific designs may benefit selected populations. [7] (10.1016/j.arth.2025.11.056)
- [L3] Physical activity equivalent to approximately 30–35 min of vigorous intensity per week appears to offset the association between abdominal obesity and incident CVD. [8] (10.1136/bjsports-2023-107252)
- [L2] No significant differences were observed between above-average and below-average BMI groups, and BMI was not correlated with clinical improvements. [9] (10.1016/j.xrrt.2025.100634)
- [L3] These findings suggest that increasing obesity severity is not associated with higher rates of postoperative stiffness or inferior outcomes following MUA and that concern for stiffness alone should not serve as a categorical barrier to TKA or MUA when clinically indicated. [10] (10.1016/j.arth.2026.03.080)
- [L3] These findings suggest modern surgical practices and implant designs may have mitigated traditional obesity-related risks. [11] (10.1016/j.arth.2026.04.031)
- [Paper] It is clear that, when combined with liraglutide treatment, exercise results in a more holistic state of health that may result in improved longer-term health and may enhance adherence to the treatment and promote longer-term weight-loss maintenance. [12] (10.1136/bjsports-2021-104754)
- [L1] An aggregate exercise programme energy expenditure (>10 000 kcal) may be required to promote reductions in intrahepatic fat. [13] (10.1136/bjsports-2016-096197)
- [L3] However, obesity remains a critical risk factor for mechanical failures. [14] (10.1016/j.jisako.2025.100861)
- [L3] In this cohort of obese patients who underwent THA, the WHO obesity class was not associated with risk, invasiveness, or timing of reoperations. [15] (10.1016/j.arth.2025.07.026)
- [L3] Obese and overweight patients converted to THA at significantly higher rates compared with normal-weight patients. [16] (10.1177/03635465251400355)
- [L3] Semaglutide appears to be a safe alternative to bariatric surgery for weight management before THA, with similar implant survival and postoperative complication rates. [17] (10.1016/j.arth.2025.08.068)
- [L3] Women had decreased odds of losing greater than five pounds before surgery despite increased odds of having preoperative bariatric surgery. [18] (10.1016/j.arth.2026.06.021)
- [L3] Unlike BMI, the STiB ratio reflects local anatomical factors that directly influence surgical exposure and wound healing. [19] (10.1016/j.arth.2025.09.022)
- [L1] Following MMPRT repair, repairs show progression of osteoarthritis with higher rates seen with elevated BMI. [20] (10.1002/arj.70028)
- [L3] BMI has a weak-to-moderate association with peri-incisional adiposity in primary total joint arthroplasty patients. [21] (10.1016/j.arth.2024.08.020)
- [L2] However, a nonsignificant trend toward a higher complication rate was observed in patients with severe obesity (BMI ≥35 kg/m2), while a statistically significant increase in arthrofibrosis was found in patients with BMI <25 kg/m2. [22] (10.1016/j.jisako.2025.100927)
- [L3] Obesity has an increased risk of all-cause revisions and revision for instability or dislocation in patients receiving rTSA indicated for fractures. [23] (10.1016/j.jse.2025.05.036)
- [L3] In morbidly obese patients, DM implants demonstrated excellent five-year survivorship with outcomes comparable or slightly superior to fixed-bearing constructs. [24] (10.1016/j.arth.2026.03.075)
- [L3] Hip arthroscopy for the treatment of FAI and labral tears in patients with obesity yielded significant and sustainable long-term improvements, which were equivalent to those of a benchmark matched control group of normal-weight patients. [25] (10.1177/03635465251392585)
- [L1] Total weight loss % was higher in bariatric surgery patients (28.7%, P < 0.001). [26] (10.1016/j.arth.2026.05.033)
- [L1] Additionally, women with HIIT training had significant reduction in their weight and BMI compared to those who followed MICT training protocol. [27] (10.1186/s12891-026-09722-z)
- [L3] The ten-year functional outcomes and revision rates of THA do not justify restricting access to surgery on the basis of BMI. [28] (10.1016/j.arth.2025.07.044)
- [L3] Based on AOANJRR data, obese patients are at increased risk of higher rate of revision following UKA. [31] (10.1177/2325967125s00336)
References¶
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[19] Soft Tissue-To-Bone Ratio Outperforms Body Mass Index in Predicting Periprosthetic Joint Infection in Total Knee Arthroplasty: A Retrospective Case-Control Study. The Journal of Arthroplasty. 2026. DOI: 10.1016/j.arth.2025.09.022
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[21] Body Mass Index is Not an Appropriate Proxy for the Condition of Peri-Incisional Adiposity in Primary Total Joint Arthroplasty Patients. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2024.08.020
[22] Impact of body mass index on robotic-assisted total knee arthroplasty outcomes: A retrospective cohort analysis. Journal of ISAKOS. 2025. DOI: 10.1016/j.jisako.2025.100927
[23] Revision rates between obese and nonobese total shoulder arthroplasty patients: an Australian registry data study. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2025.05.036
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[25] Obese Patients Treated by Hip Arthroscopy for Femoroacetabular Impingement Syndrome — 10-Year Functional Outcomes and Conversion Rates to Arthroplasty Compared With Normal-Weight Patients. The American Journal of Sports Medicine. 2026. DOI: 10.1177/03635465251392585
[26] Impact Of Prior Bariatric Surgery Versus Immediate Total Knee Arthroplasty On Knee Function Among Patients Who Have Severe Obesity And Advanced Knee Osteoarthritis: The SWIFT Trial. The Journal of Arthroplasty. 2026. DOI: 10.1016/j.arth.2026.05.033
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