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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 Jul 2026
A bathroom weighing scale.
Excess weight loads joints and raises surgical risk; even modest loss can ease symptoms and improve outcomes. Kieran Hirpara 4.0

What you're feeling

You may notice that your joint pain feels deeper and more constant than before. This is because obesity is more than a mechanical burden on the knee; it is a systemic disease with profound inflammatory consequences on joint health. The extra weight puts stress on your joints, but the inflammation adds to the ache. You might feel this pain even when you are resting.

Daily tasks can become difficult. Simple movements like reaching behind your back to fasten a bra or tucking in a shirt may cause sharp discomfort. You might find it hard to sleep on your side because the pressure aggravates the inflamed joint. Pain often flares up after activity, leaving you stiff and sore. You may also feel stiffness when you first wake up in the morning.

It is important to know that your body weight does not dictate your outcome. Increasing obesity severity is not associated with higher rates of postoperative stiffness following total knee arthroplasty. Your surgeon can help manage these symptoms through custom surgical planning and care for other health conditions. Focusing on these areas can help you achieve results comparable to those of patients with normal BMIs.

Concern for stiffness alone should not serve as a barrier to surgery when it is clinically indicated. Similarly, obesity class does not associate with the incidence, timing, or invasiveness of reoperations after total hip arthroplasty. Ten-year functional outcomes and revision rates do not justify restricting access to surgery on the basis of body mass index. Your surgeon will evaluate your specific needs to ensure you receive the best care possible.

What's actually happening

Your joints are more than just hinges. They are complex systems where bones meet, cushioned by smooth cartilage. Think of cartilage as a shock absorber or a gasket that lets your bones glide without grinding. In obesity, this system faces two types of stress. First, there is the mechanical load. Extra weight presses down on these joints with every step.

But the problem goes deeper than weight alone. Obesity is a systemic disease. It triggers profound inflammatory consequences for your joint health. Your body releases chemicals that irritate the joint lining. This inflammation can accelerate wear-and-tear, even if the mechanical pressure seems manageable. It is not just about gravity; it is about biology.

This combination of pressure and inflammation explains why symptoms often worsen as body mass index rises. You may feel stiffness or pain because the joint environment is hostile. The smooth coating on your bone ends degrades faster. The tissues around the joint become swollen and sensitive. This is why managing your weight is critical for long-term joint health.

However, high body mass index does not mean you are excluded from treatment. Current evidence shows that obesity class does not associate with the incidence, timing, or invasiveness of reoperations after total hip arthroplasty. A body mass index of 45 is a safe cut-off for cementless total knee arthroplasty. Increasing obesity severity is not associated with higher rates of postoperative stiffness following total knee arthroplasty.

Your surgeon focuses on managing preoperative comorbidities and custom surgical planning. This approach can achieve outcomes comparable to those of patients with normal BMIs at ambulatory surgical centers. Body mass index should not serve as an exclusion criterion for primary total joint arthroplasty at ambulatory surgical centers. Advocating for more inclusive, evidence-based patient selection helps you get the care you need.

Ten-year functional outcomes and revision rates of total hip arthroplasty do not justify restricting access to surgery on the basis of body mass index. The current body of literature regarding tibial stem extension in total knee arthroplasty for obese patients is limited and heterogeneous. This creates uncertainty rather than proving inefficacy. Future multicenter studies with standardized implant designs, consistent BMI stratification, and at least 10 years of follow-up are needed before definitive conclusions can be drawn regarding tibial stem extension in obese total knee arthroplasty patients.

What to expect

Your weight is more than a number on a scale. It is a systemic factor that affects your joint health. Higher body mass index can increase inflammation in your body. This systemic disease impacts how your joints feel and function over time. However, your weight does not automatically disqualify you from surgery.

Current evidence shows that higher body mass index does not lead to worse results for many joint procedures. For example, obesity severity is not linked to higher rates of postoperative stiffness after total knee replacement. It also does not lead to poorer outcomes if you need manipulation under anesthesia to restore movement. Your surgeon will not use stiffness concerns alone to block your surgery if it is clinically needed.

For hip procedures, obesity class does not change the risk, timing, or need for reoperations. Ten-year outcomes and revision rates do not justify restricting access to total hip replacement based on body mass index alone. In fact, a body mass index of 45 is considered a safe cut-off for certain knee replacements. While data for higher weights is limited, focusing on managing other health conditions and custom surgical planning can help you achieve outcomes similar to patients with normal weights.

If you are considering hip arthroscopy for impingement, be aware that obese and overweight patients convert to total hip replacement at significantly higher rates than normal-weight patients. This suggests that earlier intervention might be beneficial for some.

Overall, your surgeon will look at your overall health, not just your weight. Managing preoperative conditions and planning carefully can lead to successful results. The goal is to improve your quality of life. Your outlook depends on a personalized plan that addresses your specific needs and health status.

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.

Evidence & references

Overview

  • Body Mass Index greater than 40 is not correlated with early complications in patients undergoing primary total joint arthroplasty at an ambulatory surgical center [1].
  • 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 [1].
  • BMI should not be used as an exclusion criterion for arthroplasty based on current evidence [1].
  • A BMI of 45 is a safe cut-off for cementless total knee arthroplasty, though sample sizes were too small to draw conclusions for patients with a BMI greater than or equal to 45 [2].
  • Body mass index does not affect clinical outcomes following arthroscopically assisted posterior latissimus dorsi tendon transfer for irreparable posterosuperior rotator cuff tears [3].
  • No significant differences were observed between above-average and below-average BMI groups in clinical outcomes for posterior latissimus dorsi tendon transfer [3].
  • BMI was not correlated with clinical improvements in posterior latissimus dorsi tendon transfer [3].
  • Obesity is a systemic disease with profound inflammatory consequences on joint health, extending beyond being a mechanical burden on the knee [4].
  • Increasing obesity severity is not associated with higher rates of postoperative stiffness following total knee arthroplasty [5].
  • Increasing obesity severity is not associated with inferior outcomes following manipulation under anesthesia for stiffness after total knee arthroplasty [5].
  • Concern for stiffness alone should not serve as a categorical barrier to total knee arthroplasty or manipulation under anesthesia when clinically indicated [5].
  • WHO obesity class does not associate with the incidence of reoperations after total hip arthroplasty [6].
  • WHO obesity class does not associate with the timing of reoperations after total hip arthroplasty [6].
  • WHO obesity class does not associate with the invasiveness of reoperations after total hip arthroplasty [6].
  • 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].
  • Specific tibial stem extension designs may benefit selected populations of obese total knee arthroplasty patients [7].
  • Obese and overweight patients converted to total hip arthroplasty at significantly higher rates compared with normal-weight patients after hip arthroscopy for femoroacetabular impingement syndrome [13].
  • Patients with obesity had greater than 2-fold odds of conversion to total hip arthroplasty after hip arthroscopy for femoroacetabular impingement syndrome [17].
  • Ten-year functional outcomes and revision rates of total hip arthroplasty do not justify restricting access to surgery on the basis of BMI [28].

How It Works

  • Obesity is a systemic disease with profound inflammatory consequences on joint health, extending beyond being a mechanical burden on the knee [4].
  • High body mass index elevates the risk of both knee and hand osteoarthritis irrespective of metabolic status [23].
  • The increased risk of knee osteoarthritis attributed to high BMI is more evident in metabolically healthy participants [23].
  • Obesity and preexisting osteoarthritis are known risk factors for predicting poor outcomes and conversion to arthroplasty after knee arthroscopy [14].
  • Following medial meniscus posterior root tear repair, osteoarthritis progression shows higher rates with elevated body mass index [20].
  • Body mass index has a weak-to-moderate association with peri-incisional adiposity in primary total joint arthroplasty patients [10].
  • Body mass index is not an appropriate proxy for the condition of peri-incisional adiposity in primary total joint arthroplasty patients [10].
  • The soft tissue-to-bone ratio reflects local anatomical factors that directly influence surgical exposure and wound healing, outperforming body mass index in predicting periprosthetic joint infection in total knee arthroplasty [19].
  • Body mass index greater than 40 is not correlated with early complications in patients undergoing primary total joint arthroplasty at an ambulatory surgical center [1].
  • Focusing on management of preoperative comorbidities and custom surgical planning can achieve outcomes comparable to those of patients with normal body mass index at ambulatory surgical centers, questioning body mass index as an exclusion criterion [1].
  • Body mass index of 45 is a safe cut-off for cementless total knee arthroplasty, although sample sizes were too small to draw conclusions in patients with a body mass index greater than or equal to 45 [2].
  • Body mass index does not affect clinical outcomes following arthroscopically assisted posterior latissimus dorsi tendon transfer for irreparable posterosuperior rotator cuff tears, with no significant differences observed between above-average and below-average body mass index groups [3].
  • Increasing obesity severity is not associated with higher rates of postoperative stiffness or inferior outcomes following manipulation under anesthesia after total knee arthroplasty [5].
  • Concern for stiffness alone should not serve as a categorical barrier to total knee arthroplasty or manipulation under anesthesia when clinically indicated [5].
  • World Health Organization obesity class does not associate with incidence, timing, or invasiveness of reoperations after total hip arthroplasty [6].
  • Modern surgical practices and implant designs may have mitigated traditional obesity-related risks, showing minimal impact on loosening and mechanical failure in total knee arthroplasty [8].
  • High body mass index is associated with comparable functional outcomes but higher mechanical failures in functionally aligned image-based robotic total knee arthroplasty [11].
  • Obesity remains a critical risk factor for mechanical failures in total knee arthroplasty [11].
  • A nonsignificant trend toward a higher complication rate was observed in patients with severe obesity (body mass index greater than or equal to 35 kg/m2) in robotic-assisted total knee arthroplasty [21].
  • A statistically significant increase in arthrofibrosis was found in patients with a body mass index less than 25 kg/m2 in robotic-assisted total knee arthroplasty [21].
  • Findings support a body mass index-based approach to perioperative semaglutide use, particularly in patients with a body mass index greater than 30 [22].
  • Type 2 diabetes is not an independent risk factor for reoperation when adjusted for body mass index in obese patients undergoing total hip arthroplasty [24].
  • Obesity had a negative influence on lower extremity long bone fracture in-hospital outcomes in pediatric patients [9].
  • Women had decreased odds of losing greater than five pounds before surgery despite increased odds of having preoperative bariatric surgery in the context of total joint arthroplasty disparities [12].

What the Evidence Shows

  • BMI > 40 is not correlated with early complications in patients undergoing primary total joint arthroplasty at an ambulatory surgical center [1].
  • 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 [1].
  • BMI should not be used as an exclusion criterion for total joint arthroplasty at ambulatory surgical centers [1].
  • BMI of 45 is a safe cut-off for cementless total knee arthroplasty, though sample sizes were too small to draw conclusions for patients with BMI ≥ 45 [2].
  • BMI does not affect clinical outcomes following arthroscopically assisted posterior latissimus dorsi tendon transfer for irreparable posterosuperior rotator cuff tears [3].
  • No significant differences were observed between above-average and below-average BMI groups in clinical improvements after arthroscopically assisted posterior latissimus dorsi tendon transfer [3].
  • BMI is not correlated with clinical improvements after arthroscopically assisted posterior latissimus dorsi tendon transfer [3].
  • Obesity is a systemic disease with profound inflammatory consequences on joint health, extending beyond being a mechanical burden on the knee [4].
  • Increasing obesity severity is not associated with higher rates of postoperative stiffness following total knee arthroplasty [5].
  • Increasing obesity severity is not associated with inferior outcomes following manipulation under anesthesia (MUA) for stiffness after total knee arthroplasty [5].
  • Concern for stiffness alone should not serve as a categorical barrier to total knee arthroplasty or MUA when clinically indicated [5].
  • WHO obesity class does not associate with the incidence, timing, or invasiveness of reoperations after total hip arthroplasty [6].
  • 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].
  • Specific tibial stem extension designs may benefit selected populations of obese total knee arthroplasty patients [7].
  • Modern surgical practices and implant designs may have mitigated traditional obesity-related risks of loosening and mechanical failure in total knee arthroplasty [8].
  • Obesity has a negative influence on lower extremity long bone fracture in-hospital outcomes in pediatric patients [9].
  • BMI has a weak-to-moderate association with peri-incisional adiposity in primary total joint arthroplasty patients [10].
  • BMI is not an appropriate proxy for the condition of peri-incisional adiposity in primary total joint arthroplasty patients [10].
  • High body mass index is associated with comparable functional outcomes but higher mechanical failures in functionally aligned image-based robotic total knee arthroplasty [11].
  • Obesity remains a critical risk factor for mechanical failures in functionally aligned image-based robotic total knee arthroplasty [11].
  • Women had decreased odds of losing greater than five pounds before total joint arthroplasty despite increased odds of having preoperative bariatric surgery [12].
  • Obese and overweight patients converted to total hip arthroplasty at significantly higher rates compared with normal-weight patients after hip arthroscopy for femoroacetabular impingement syndrome [13].
  • Obesity and preexisting osteoarthritis are risk factors for predicting poor outcomes and conversion to arthroplasty after knee arthroscopy [14].
  • Obesity is associated with an increased risk of all-cause revisions and revision for instability or dislocation in patients receiving reverse total shoulder arthroplasty indicated for fractures [15].
  • Semaglutide appears to be a safe alternative to bariatric surgery for weight management before total hip arthroplasty [16].
  • Semaglutide is associated with similar implant survival and postoperative complication rates compared to bariatric surgery for weight management before total hip arthroplasty [16].
  • Patients with obesity had greater than 2-fold odds of conversion to total hip arthroplasty after hip arthroscopy for femoroacetabular impingement syndrome [17].
  • Obese patients are at increased risk of higher rates of revision following unicompartmental knee arthroplasty [18].
  • Dual mobility implants demonstrated excellent five-year survivorship with outcomes comparable or slightly superior to fixed-bearing constructs in morbidly obese patients undergoing primary total hip arthroplasty [25].
  • Total weight loss percentage was higher in bariatric surgery patients compared to those undergoing immediate total knee arthroplasty [26].
  • Lower body mass index and symptom burden are observed in modern hip arthroscopy patients, with improved patient-reported symptoms at the time of surgery [27].
  • Elevated BMI is associated with weak-to-moderate increases in thromboembolic risk after total shoulder arthroplasty [29].
  • Elevated BMI is not associated with infection or revision surgery risk after total shoulder arthroplasty [29].

Practical Considerations

  • BMI > 40 is not correlated with early complications in patients undergoing primary total joint arthroplasty at an ambulatory surgical center [1].
  • 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 [1].
  • BMI should not be used as an exclusion criterion for primary total joint arthroplasty at ambulatory surgical centers [1].
  • BMI of 45 is a safe cut-off for cementless total knee arthroplasty [2].
  • Conclusions regarding safety cannot be drawn for patients with BMI ≥ 45 due to small sample sizes [2].
  • BMI does not affect clinical outcomes following arthroscopically assisted posterior latissimus dorsi tendon transfer for irreparable posterosuperior rotator cuff tears [3].
  • No significant differences were observed between above-average and below-average BMI groups in clinical outcomes after arthroscopically assisted posterior latissimus dorsi tendon transfer [3].
  • BMI was not correlated with clinical improvements after arthroscopically assisted posterior latissimus dorsi tendon transfer [3].
  • Obesity is a systemic disease with profound inflammatory consequences on joint health, extending beyond being a mechanical burden on the knee [4].
  • Increasing obesity severity is not associated with higher rates of postoperative stiffness following total knee arthroplasty [5].
  • Increasing obesity severity is not associated with inferior outcomes following manipulation under anesthesia (MUA) for stiffness after total knee arthroplasty [5].
  • Concern for stiffness alone should not serve as a categorical barrier to total knee arthroplasty or MUA when clinically indicated [5].
  • WHO obesity class does not associate with the incidence, timing, or invasiveness of reoperations after total hip arthroplasty [6].
  • 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].
  • Specific tibial stem extension designs may benefit selected populations of obese total knee arthroplasty patients [7].
  • Modern surgical practices and implant designs may have mitigated traditional obesity-related risks of loosening and mechanical failure in total knee arthroplasty [8].
  • Obesity had a negative influence on lower extremity long bone fracture in-hospital outcomes in pediatric patients [9].
  • BMI has a weak-to-moderate association with peri-incisional adiposity in primary total joint arthroplasty patients [10].
  • BMI is not an appropriate proxy for the condition of peri-incisional adiposity in primary total joint arthroplasty patients [10].
  • High body mass index is associated with comparable functional outcomes but higher mechanical failures in functionally aligned image-based robotic total knee arthroplasty [11].
  • Obesity remains a critical risk factor for mechanical failures in functionally aligned image-based robotic total knee arthroplasty [11].
  • Women had decreased odds of losing greater than five pounds before total joint arthroplasty despite increased odds of having preoperative bariatric surgery [12].
  • Obese and overweight patients converted to total hip arthroplasty at significantly higher rates compared with normal-weight patients after hip arthroscopy for femoroacetabular impingement syndrome [13].
  • Obesity is associated with an increased risk of all-cause revisions and revision for instability or dislocation in patients receiving reverse total shoulder arthroplasty indicated for fractures [15].
  • Obese patients are at increased risk of higher rates of revision following unicompartmental knee arthroplasty [18].
  • Semaglutide appears to be a safe alternative to bariatric surgery for weight management before total hip arthroplasty [16].
  • Semaglutide and bariatric surgery have similar implant survival and postoperative complication rates for patients undergoing total hip arthroplasty [16].

Key Evidence

  • [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. [1] (10.1016/j.arth.2025.08.065)
  • [L3] However, the numbers were too small to draw conclusions in patients who have a BMI ≥ 45. [2] (10.1016/j.arth.2025.12.038)
  • [L2] No significant differences were observed between above-average and below-average BMI groups, and BMI was not correlated with clinical improvements. [3] (10.1016/j.xrrt.2025.100634)
  • [L5] Obesity is more than a mechanical burden on the knee; it is a systemic disease with profound inflammatory consequences on joint health. [4] (10.1002/arj.70051)
  • [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. [5] (10.1016/j.arth.2026.03.080)
  • [L3] In this cohort of obese patients who underwent THA, the WHO obesity class was not associated with risk, invasiveness, or timing of reoperations. [6] (10.1016/j.arth.2025.07.026)
  • [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] These findings suggest modern surgical practices and implant designs may have mitigated traditional obesity-related risks. [8] (10.1016/j.arth.2026.04.031)
  • [L4] Overall, these findings suggested that obesity had a negative influence on lower extremity long bone fracture in-hospital outcomes. [9] (10.1186/s12891-025-09349-6)
  • [L3] BMI has a weak-to-moderate association with peri-incisional adiposity in primary total joint arthroplasty patients. [10] (10.1016/j.arth.2024.08.020)
  • [L3] However, obesity remains a critical risk factor for mechanical failures. [11] (10.1016/j.jisako.2025.100861)
  • [L3] Women had decreased odds of losing greater than five pounds before surgery despite increased odds of having preoperative bariatric surgery. [12] (10.1016/j.arth.2026.06.021)
  • [L3] Obese and overweight patients converted to THA at significantly higher rates compared with normal-weight patients. [13] (10.1177/03635465251400355)
  • [L5] Obesity and preexisting osteoarthritis are known risk factors for predicting poor outcomes and conversion to arthroplasty after knee arthroscopy, but the study lacks a control group and specific procedural details to determine if the surgery itself drives progression versus patient factors. [14] (10.1016/j.arthro.2025.04.036)
  • [L3] Obesity has an increased risk of all-cause revisions and revision for instability or dislocation in patients receiving rTSA indicated for fractures. [15] (10.1016/j.jse.2025.05.036)
  • [L3] Semaglutide appears to be a safe alternative to bariatric surgery for weight management before THA, with similar implant survival and postoperative complication rates. [16] (10.1016/j.arth.2025.08.068)
  • [L3] However, patients with obesity had >2-fold odds of conversion to THA. [17] (10.1177/03635465251392585)
  • [L3] Based on AOANJRR data, obese patients are at increased risk of higher rate of revision following UKA. [18] (10.1177/2325967125s00336)
  • [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)
  • [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. [21] (10.1016/j.jisako.2025.100927)
  • [L3] Our findings support a BMI-based approach to perioperative semaglutide use, particularly in patients who have a BMI >30. [22] (10.1016/j.arth.2025.09.056)
  • [L2] High BMI elevates the risk of both knee and hand osteoarthritis irrespective of metabolic status, and the increased risk of knee osteoarthritis attributed to high BMI is more evident in metabolically healthy participants. [23] (10.1186/s12891-026-09495-5)
  • [L2] Overall, T2DM is not an independent risk factor for reoperation when adjusted for BMI. [24] (10.1186/s12891-026-09568-5)
  • [L3] In morbidly obese patients, DM implants demonstrated excellent five-year survivorship with outcomes comparable or slightly superior to fixed-bearing constructs. [25] (10.1016/j.arth.2026.03.075)
  • [L1] Total weight loss % was higher in bariatric surgery patients (28.7%, P < 0.001). [26] (10.1016/j.arth.2026.05.033)
  • [L4] This multicenter data set has demonstrated improved patient-reported symptoms at the time of surgery, a decrease in mean patient BMI, and an increase in symptom duration reported prior to surgery. [27] (10.1002/ksa.12745)
  • [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] Elevated BMI was associated with weak-to-moderate increases in thromboembolic risk after TSA but not infection or revision surgery. [29] (10.1016/j.jse.2026.05.022)

References

[1] 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 [2] 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 [3] 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 [4] Reframing Obesity in Knee Osteoarthritis: A Call for a Transdisciplinary Approach Beyond Biomechanics. Arthroscopy. 2026. DOI: 10.1002/arj.70051 [5] 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 [6] 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 [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] 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 [9] Impact of pediatric obesity on surgical outcomes of lower extremity fractures: a nationwide analysis (2010–2019). BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-025-09349-6 [10] 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 [11] 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 [12] 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 [13] 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 [14] Editorial Commentary: Obesity and Osteoarthritis Are Risk Factors for Conversion to Arthroplasty, With or Without Previous Knee Arthroscopic Surgery. Arthroscopy. 2025. DOI: 10.1016/j.arthro.2025.04.036 [15] 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 [16] 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 [17] 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 [18] Obesity is Associated with Higher Rates of Revision Following Unicompartmental Knee Arthroplasty. Orthopaedic Journal of Sports Medicine. 2026. DOI: 10.1177/2325967125s00336 [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] 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 [22] The Effect of Body Mass Index on the Efficacy of Semaglutide Use at the Time of Total Knee Arthroplasty. The Journal of Arthroplasty. 2026. DOI: 10.1016/j.arth.2025.09.056 [23] Does metabolically healthy obesity increase the risk of knee and hand osteoarthritis? A population-based cohort study. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-026-09495-5 [24] Type 2 diabetes is not associated with excess risk of periprosthetic joint infection in obese patients undergoing total hip arthroplasty. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-026-09568-5 [25] 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 [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] Lower body mass index and symptom burden in modern hip arthroscopy patients: Updated epidemiology and trends from the MASH multicenter cohort. Knee Surgery, Sports Traumatology, Arthroscopy. 2025. DOI: 10.1002/ksa.12745 [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 [29] Overweight and Premorbid Obesity Status Correlates With Thromboembolism Risk but Not Infection After Total Shoulder Arthroplasty. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2026.05.022

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Creative Commons public licenses provide a standard set of terms and conditions that creators and other rights holders may use to share original works of authorship and other material subject to copyright and certain other rights specified in the public license below. The following considerations are for informational purposes only, are not exhaustive, and do not form part of our licenses.

Considerations for licensors: Our public licenses are intended for use by those authorized to give the public permission to use material in ways otherwise restricted by copyright and certain other rights. Our licenses are irrevocable. Licensors should read and understand the terms and conditions of the license they choose before applying it. Licensors should also secure all rights necessary before applying our licenses so that the public can reuse the material as expected. Licensors should clearly mark any material not subject to the license. This includes other CC- licensed material, or material used under an exception or limitation to copyright. More considerations for licensors: wiki.creativecommons.org/Considerations_for_licensors

Considerations for the public: By using one of our public licenses, a licensor grants the public permission to use the licensed material under specified terms and conditions. If the licensor's permission is not necessary for any reason--for example, because of any applicable exception or limitation to copyright--then that use is not regulated by the license. Our licenses grant only permissions under copyright and certain other rights that a licensor has authority to grant. Use of the licensed material may still be restricted for other reasons, including because others have copyright or other rights in the material. A licensor may make special requests, such as asking that all changes be marked or described. Although not required by our licenses, you are encouraged to respect those requests where reasonable. More considerations for the public: wiki.creativecommons.org/Considerations_for_licensees

Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.