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Weight, Obesity and Joint Health

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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.

Updated Sep 202627 citations

Excess weight loads joints and raises surgical risk; even modest loss can ease symptoms and improve outcomes. Kieran Hirpara 4.0

What it is

Weight and joint health are closely linked. Carrying extra weight affects more than your knees. Obesity is a whole-body condition that causes inflammation, and that inflammation reaches your joints too [1]. It is not just about the extra load your joints carry each day.

A high BMI raises the risk of wear-and-tear arthritis (osteoarthritis) in your knees and hands, even in people who are otherwise healthy [2]. Fat stored around your middle (central obesity) is also linked with arthritis in the shoulder joint [3]. If you are considering joint surgery, weight is one of the things your doctor will talk about with you.

The way weight and activity work together is not well understood by many people. Far more attention has been paid to diet than to physical inactivity as a cause of obesity [4]. Movement matters. Being fit protects your heart and overall health, and it softens some of the risks that come with extra weight [5]. Even small amounts of vigorous activity, around 30 to 35 minutes a week, appear to offset the link between abdominal obesity and heart disease [6].

Weight is something you can change. Addressing obesity can improve joint health and overall health, including in children [7]. If you are preparing for joint replacement surgery, managing your weight and other health conditions beforehand can lead to outcomes similar to those of patients with a normal BMI [8].

Does it work?

The honest answer is that it depends on what "it" is. For weight loss itself, surgery works better than going straight to a knee replacement when someone has severe obesity and advanced arthritis. In one study, people who had weight loss surgery lost 28.7% of their body weight, while those who had a knee replacement straight away lost less [1]. Newer weight loss medicines are another option. One study found that a medicine called semaglutide was a safe alternative to weight loss surgery before hip replacement, with similar implant survival and complication rates [2].

When it comes to joint replacement surgery itself, the picture is more mixed than many people expect. Having a higher BMI does not automatically mean a worse result. Studies have found that a BMI over 40 was not linked with early complications in knee replacement when other health conditions were managed first and planning was tailored to the patient [3]. Hip replacement studies found that the severity of obesity did not change the risk, invasiveness or timing of further operations [4]. Shoulder replacement studies found BMI was not linked with a higher risk of needing revision surgery [5]. On the other hand, some studies did find higher risks. People with obesity who had keyhole hip surgery were more than twice as likely to need a full hip replacement later compared with people of normal weight [6]. Obesity also raised the risk of needing revision after partial knee replacement [7].

Some of this evidence is strong, and some of it is not. A few of these findings come from small studies, so the results are less certain. For example, one study suggested a BMI of 45 was a safe cut-off for one type of knee replacement, but the groups were too small to be sure [8]. Exercise can help too. Women with a combination of low muscle mass and obesity who did high-intensity interval training lost more weight and had lower BMI than those doing steady moderate exercise [9]. Combining exercise with weight loss medicine may also support better long-term health and help keep weight off [10].

What are the risks?

The risks depend on which operation you are having. For knee replacement, modern surgical methods and implant designs appear to have reduced the older problems with loosening and mechanical failure in people with obesity [1]. But some risks remain. Obesity is still a major risk factor for mechanical failure with one type of robotic knee replacement, even though day-to-day function afterwards was similar [2]. People with severe obesity, a BMI of 35 or more, showed a trend towards more complications after robotic knee replacement, though the difference was not clear-cut [3]. If you have a partial knee replacement rather than a full one, obesity raises the chance of needing revision surgery [4].

For hip and shoulder surgery, the picture is calmer. After hip replacement, the severity of your obesity did not change the risk, invasiveness or timing of further operations [5]. Having type 2 diabetes on top of obesity did not add extra risk of reoperation once BMI was accounted for [6]. After shoulder replacement, BMI was not linked with a higher chance of revision surgery [7], though overweight and obesity were linked with blood clot risk, not infection [8].

Keyhole surgery carries different risks. If you have keyhole hip surgery for a painful impingement, obesity more than doubles the chance you will later need a full hip replacement [9]. Obesity and arthritis that already exists also predict poorer results after keyhole knee surgery [10]. After a meniscus root repair, arthritis progressed faster in people with a higher BMI [11].

Some findings are less certain. One study suggested a BMI of 45 was a safe cut-off for one type of knee replacement, but the groups were too small to be sure [12]. Evidence on adding extra implant support in knee replacement for people with obesity is limited and inconsistent [13]. Wound healing depends more on the thickness of soft tissue over the bone than on BMI alone [14].

Very few people with obesity receive weight loss treatment before joint replacement, through medicines, nutrition services or weight loss surgery [15]. Where weight is a concern, that is something worth discussing with your doctor beforehand.

Is it right for you?

Joint replacement can work well for people with a higher BMI. Studies found that a BMI over 40 was not linked with early complications in knee replacement [1]. Hip replacement studies found that how severe your obesity is did not change the risk, invasiveness or timing of further operations [2]. Shoulder replacement studies found BMI was not linked with a higher chance of needing revision surgery [3]. So a higher weight on its own does not rule you out.

There are limits. One study suggested a BMI of 45 was a safe cut-off for one type of knee replacement, but the groups were too small to be sure [4]. If you are considering keyhole hip surgery rather than replacement, obesity more than doubles the chance you will need a full hip replacement later [5]. Weight loss before surgery is another path. Newer medicines such as semaglutide have been studied as a safe alternative to weight loss surgery before hip replacement [6]. Yet very few people with obesity are offered weight loss treatment before joint replacement, through medicines, nutrition services or weight loss surgery [7].

The right choice depends on your weight, your arthritis and your other health conditions. The risks section above sets out what can go wrong with each option. Talk it through with your doctor. This is a shared decision, and it is one you make together.

The bottom line

Extra weight does not rule you out of joint surgery, but it changes the conversation. For knee and hip replacement, a higher BMI alone was not linked with more early problems when other health conditions were managed first [1]. The main caveat is keyhole surgery: obesity more than doubles the chance you will need a full hip replacement later [2]. Weight loss before surgery is an option worth discussing, though very few people are actually offered it [3].

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Reviewed by Kieran Hirpara · 13 June 2026.

Want the clinical detail? Read the clinician version.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

References

1. Reframing Obesity in Knee Osteoarthritis: A Call for a Transdisciplinary Approach Beyond Biomechanics. *Arthroscopy*. 2026. 10.1002/arj.70051
2. Does metabolically healthy obesity increase the risk of knee and hand osteoarthritis? A population-based cohort study. *BMC Musculoskeletal Disorders*. 2026. 10.1186/s12891-026-09495-5
3. Association between central obesity and the risk of glenohumeral joint osteoarthritis: a prospective study. *Journal of Shoulder and Elbow Surgery*. 2026. 10.1016/j.jse.2025.07.007
4. It is time to bust the myth of physical inactivity and obesity: you cannot outrun a bad diet. *British Journal of Sports Medicine*. 2015. 10.1136/bjsports-2015-094911
5. Cardiorespiratory fitness, body mass index and mortality: a systematic review and meta-analysis. *British Journal of Sports Medicine*. 2024. 10.1136/bjsports-2024-108748
6. Joint associations of device-measured physical activity and abdominal obesity with incident cardiovascular disease: a prospective cohort study. *British Journal of Sports Medicine*. 2023. 10.1136/bjsports-2023-107252
7. The Role of Obesity in Pediatric Orthopedics. *JAAOS: Global Research and Reviews*. 2019. 10.5435/jaaosglobal-d-19-00036
8. Body Mass Index > 40 Is Not Correlated With Early Complications in Patients Undergoing Primary Total Joint Arthroplasty at an Ambulatory Surgical Center. *The Journal of Arthroplasty*. 2026. 10.1016/j.arth.2025.08.065
9. 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. 10.1016/j.arth.2026.05.033
10. Is Semaglutide a Safer Weight-Management Option Than Bariatric Surgery for Patients Undergoing Total Hip Arthroplasty (THA)?. *The Journal of Arthroplasty*. 2026. 10.1016/j.arth.2025.08.068
11. Obesity Class Does Not Associate With Incidence, Timing, or Invasiveness of Reoperations After Total Hip Arthroplasty. *The Journal of Arthroplasty*. 2026. 10.1016/j.arth.2025.07.026
12. Revision rates between obese and nonobese total shoulder arthroplasty patients: an Australian registry data study. *Journal of Shoulder and Elbow Surgery*. 2026. 10.1016/j.jse.2025.05.036
13. 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. 10.1177/03635465251392585
14. Obesity is Associated with Higher Rates of Revision Following Unicompartmental Knee Arthroplasty. *Orthopaedic Journal of Sports Medicine*. 2026. 10.1177/2325967125s00336
15. Body Mass Index of 45 Is a Safe Cut-Off for Cementless Total Knee Arthroplasty. *The Journal of Arthroplasty*. 2025. 10.1016/j.arth.2025.12.038
16. Impact of high-intensity interval training vs. moderate-intensity continuous training combined with strength training on physical and metabolic outcomes in post-bariatric surgery patients with sarcopenic obesity. *BMC Musculoskeletal Disorders*. 2026. 10.1186/s12891-026-09722-z
17. Exercise in the maintenance of weight loss: health benefits beyond lost weight on the scale. *British Journal of Sports Medicine*. 2021. 10.1136/bjsports-2021-104754
18. Obesity and Total Knee Arthroplasty Revisited: Minimal Impact on Loosening and Mechanical Failure in the Modern Era. *The Journal of Arthroplasty*. 2026. 10.1016/j.arth.2026.04.031
19. Impact of high body mass index on functionally aligned image-based robotic total knee arthroplasty: Comparable functional outcomes but higher mechanical failures. *Journal of ISAKOS*. 2025. 10.1016/j.jisako.2025.100861
20. Impact of body mass index on robotic-assisted total knee arthroplasty outcomes: A retrospective cohort analysis. *Journal of ISAKOS*. 2025. 10.1016/j.jisako.2025.100927
21. Type 2 diabetes is not associated with excess risk of periprosthetic joint infection in obese patients undergoing total hip arthroplasty. *BMC Musculoskeletal Disorders*. 2026. 10.1186/s12891-026-09568-5
22. Overweight and Premorbid Obesity Status Correlates With Thromboembolism Risk but Not Infection After Total Shoulder Arthroplasty. *Journal of Shoulder and Elbow Surgery*. 2026. 10.1016/j.jse.2026.05.022
23. Editorial Commentary:
24. Medial Meniscus Posterior Root Tear Repairs Show Osteoarthritis Progression Over Time With Higher Rates Seen With Higher Body Mass Index. *Arthroscopy*. 2026. 10.1002/arj.70028
25. Reply to: "Letter to the Editor Commenting on: 'Current Evidence Does Not Support the Use of Tibial Stem Extension in Total Knee Arthroplasty of Obese Patients: A Systematic Review'". *The Journal of Arthroplasty*. 2026. 10.1016/j.arth.2025.11.056
26. 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. 10.1016/j.arth.2025.09.022
27. Disparities in Preoperative Weight Loss and Obesity Treatment Before Total Joint Arthroplasty. *The Journal of Arthroplasty*. 2026. 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

[1] The Role of Obesity in Pediatric Orthopedics. JAAOS: Global Research and Reviews. 2019. DOI: 10.5435/jaaosglobal-d-19-00036

[2] The association between body mass index and osteoporosis, with consideration of sex differences: a systematic review and dose-response meta-analysis. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-026-09675-3

[3] It is time to bust the myth of physical inactivity and obesity: you cannot outrun a bad diet. British Journal of Sports Medicine. 2015. DOI: 10.1136/bjsports-2015-094911

[4] Body Mass Index of 45 Is a Safe Cut-Off for Cementless Total Knee Arthroplasty. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2025.12.038

[5] Reframing Obesity in Knee Osteoarthritis: A Call for a Transdisciplinary Approach Beyond Biomechanics. Arthroscopy. 2026. DOI: 10.1002/arj.70051

[6] Body Mass Index > 40 Is Not Correlated With Early Complications in Patients Undergoing Primary Total Joint Arthroplasty at an Ambulatory Surgical Center. The Journal of Arthroplasty. 2026. DOI: 10.1016/j.arth.2025.08.065

[7] Reply to: "Letter to the Editor Commenting on: 'Current Evidence Does Not Support the Use of Tibial Stem Extension in Total Knee Arthroplasty of Obese Patients: A Systematic Review'". The Journal of Arthroplasty. 2026. DOI: 10.1016/j.arth.2025.11.056

[8] Joint associations of device-measured physical activity and abdominal obesity with incident cardiovascular disease: a prospective cohort study. British Journal of Sports Medicine. 2023. DOI: 10.1136/bjsports-2023-107252

[9] Body mass index does not affect clinical outcomes following arthroscopically assisted posterior latissimus dorsi tendon transfer for irreparable posterosuperior rotator cuff tears: a minimum 5-year follow-up study. JSES Reviews, Reports, and Techniques. 2026. DOI: 10.1016/j.xrrt.2025.100634

[10] Obesity Severity and Stiffness After Total Knee Arthroplasty Revisited: A Contemporary Analysis of Patients Requiring Manipulation Under Anesthesia. The Journal of Arthroplasty. 2026. DOI: 10.1016/j.arth.2026.03.080

[11] Obesity and Total Knee Arthroplasty Revisited: Minimal Impact on Loosening and Mechanical Failure in the Modern Era. The Journal of Arthroplasty. 2026. DOI: 10.1016/j.arth.2026.04.031

[12] Exercise in the maintenance of weight loss: health benefits beyond lost weight on the scale. British Journal of Sports Medicine. 2021. DOI: 10.1136/bjsports-2021-104754

[13] Effect of exercise training on liver function in adults who are overweight or exhibit fatty liver disease: a systematic review and meta-analysis. British Journal of Sports Medicine. 2016. DOI: 10.1136/bjsports-2016-096197

[14] Impact of high body mass index on functionally aligned image-based robotic total knee arthroplasty: Comparable functional outcomes but higher mechanical failures. Journal of ISAKOS. 2025. DOI: 10.1016/j.jisako.2025.100861

[15] Obesity Class Does Not Associate With Incidence, Timing, or Invasiveness of Reoperations After Total Hip Arthroplasty. The Journal of Arthroplasty. 2026. DOI: 10.1016/j.arth.2025.07.026

[16] The Effect of Body Mass Index on Outcomes After Hip Arthroscopy for Femoroacetabular Impingement Syndrome: A Matched Analysis With 10-Year Follow-up. The American Journal of Sports Medicine. 2026. DOI: 10.1177/03635465251400355

[17] Is Semaglutide a Safer Weight-Management Option Than Bariatric Surgery for Patients Undergoing Total Hip Arthroplasty (THA)?. The Journal of Arthroplasty. 2026. DOI: 10.1016/j.arth.2025.08.068

[18] Disparities in Preoperative Weight Loss and Obesity Treatment Before Total Joint Arthroplasty. The Journal of Arthroplasty. 2026. DOI: 10.1016/j.arth.2026.06.021

[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

[20] Medial Meniscus Posterior Root Tear Repairs Show Osteoarthritis Progression Over Time With Higher Rates Seen With Higher Body Mass Index. Arthroscopy. 2026. DOI: 10.1002/arj.70028

[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

[24] Primary Total Hip Arthroplasty in Patients Who Have Morbid Obesity: A Propensity-Weighted Analysis of Dual Mobility and Standard Fixed-Bearing Implants. The Journal of Arthroplasty. 2026. DOI: 10.1016/j.arth.2026.03.075

[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

[27] Impact of high-intensity interval training vs. moderate-intensity continuous training combined with strength training on physical and metabolic outcomes in post-bariatric surgery patients with sarcopenic obesity. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-026-09722-z

[28] Do the Ten-Year Functional Outcomes and Revision Rates of Total Hip Arthroplasty in Obese and Morbidly Obese Patients Justify Restricting Their Access to Surgery?. The Journal of Arthroplasty. 2026. DOI: 10.1016/j.arth.2025.07.044

[31] Obesity is Associated with Higher Rates of Revision Following Unicompartmental Knee Arthroplasty. Orthopaedic Journal of Sports Medicine. 2026. DOI: 10.1177/2325967125s00336