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Weight, Obesity and Joint Health

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.

Overview

Obesity is a systemic disease with profound inflammatory consequences on joint health, extending beyond its role as a mechanical burden on the knee [1]. High body mass index elevates the risk of both knee and hand osteoarthritis irrespective of metabolic status [5]. The increased risk of knee osteoarthritis attributed to high body mass index is more evident in metabolically healthy participants [5]. Central obesity is significantly associated with the risk of glenohumeral joint osteoarthritis, particularly in secondary glenohumeral joint osteoarthritis and normal body mass index populations [12]. Fat distribution should be included in the early screening and risk assessment system for glenohumeral joint osteoarthritis [12].

Modern surgical practices and implant designs may have mitigated traditional obesity-related risks, resulting in minimal impact on loosening and mechanical failure in total knee arthroplasty [8]. 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 [2]. Body mass index was not correlated with clinical improvements following arthroscopically assisted posterior latissimus dorsi tendon transfer for irreparable posterosuperior rotator cuff tears [2]. Type 2 diabetes is not associated with excess risk of periprosthetic joint infection in obese patients undergoing total hip arthroplasty [3]. Type 2 diabetes constitutes a minor risk factor for periprosthetic joint infection in individuals of normal or underweight status [3].

Body mass index greater than 40 is not correlated with early complications in patients undergoing primary total joint arthroplasty at an ambulatory surgical center [4]. Management of preoperative comorbidities and custom surgical planning can achieve outcomes comparable to those of patients with normal body mass indices at ambulatory surgical centers, questioning body mass index as an exclusion criterion [4]. A nonsignificant trend toward a higher complication rate was observed in patients with severe obesity (body mass index ≥35 kg/m2) undergoing robotic-assisted total knee arthroplasty [13]. A statistically significant increase in arthrofibrosis was found in patients with body mass index less than 25 kg/m2 undergoing robotic-assisted total knee arthroplasty [13].

Background & Causes

Obesity is a systemic disease with profound inflammatory consequences on joint health, extending beyond its role as a mechanical burden on the knee [1]. High body mass index elevates the risk of both knee and hand osteoarthritis irrespective of metabolic status [5]. The increased risk of knee osteoarthritis attributed to high body mass index is more evident in metabolically healthy participants [5].

Central obesity is significantly associated with the risk of glenohumeral joint osteoarthritis, especially in secondary glenohumeral joint osteoarthritis and normal body mass index populations [12]. Fat distribution should be included in the early screening and risk assessment system for glenohumeral joint osteoarthritis [12].

Postoperative Progression: Following medial meniscus posterior root tear repair, osteoarthritis progression shows higher rates with elevated body mass index [29]. Obesity and preexisting osteoarthritis are known risk factors for predicting poor outcomes and conversion to arthroplasty after knee arthroscopy [14].

Surgical Outcomes: Body mass index does not affect clinical outcomes following arthroscopically assisted posterior latissimus dorsi tendon transfer for irreparable posterosuperior rotator cuff tears [2]. Body mass index is not correlated with clinical improvements following arthroscopically assisted posterior latissimus dorsi tendon transfer for irreparable posterosuperior rotator cuff tears [2].

Infection Risk: Type 2 diabetes is not associated with excess risk of periprosthetic joint infection in obese patients undergoing total hip arthroplasty [3]. Type 2 diabetes constitutes a minor risk factor for periprosthetic joint infection in individuals of normal or underweight weight [3].

Tissue Assessment: Body mass index has a weak-to-moderate association with peri-incisional adiposity in primary total joint arthroplasty patients [22]. Body mass index is not an appropriate proxy for the condition of peri-incisional adiposity in primary total joint arthroplasty patients [22].

Symptoms & Presentation

Obesity is a systemic disease with profound inflammatory consequences on joint health, extending beyond its role as a mechanical burden on the knee [1]. High body mass index elevates the risk of knee osteoarthritis irrespective of metabolic status [5]. This increased risk is more evident in metabolically healthy participants [5]. High body mass index also elevates the risk of hand osteoarthritis irrespective of metabolic status [5].

Central obesity is significantly associated with the risk of glenohumeral joint osteoarthritis [12]. This association is especially evident in secondary glenohumeral joint osteoarthritis and normal body mass index populations [12].

Knee Arthroscopy Outcomes: Obesity and preexisting osteoarthritis are known risk factors for predicting poor outcomes and conversion to arthroplasty after knee arthroscopy [14]. The study linking obesity and preexisting osteoarthritis to poor outcomes lacks a control group and specific procedural details to determine if the surgery itself drives progression versus patient factors [14].

Hip Arthroscopy Trends: Modern hip arthroscopy patients demonstrate improved patient-reported symptoms at the time of surgery [19]. These patients show a decrease in mean body mass index [19]. They also report an increase in symptom duration prior to surgery [19].

Management

Obesity is a systemic disease with profound inflammatory consequences on joint health, extending beyond its role as a mechanical burden on the knee [1]. High body mass index elevates the risk of both knee and hand osteoarthritis irrespective of metabolic status [5]. The increased risk of knee osteoarthritis attributed to high BMI is more evident in metabolically healthy participants [5]. Effective osteoarthritis management during conservative and postsurgical phases must integrate mechanical, metabolic, and immunological insights to provide personalized joint preservation strategies [28].

Preoperative Optimization: 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 [25]. Findings support a BMI-based approach to perioperative semaglutide use, particularly in patients with a BMI greater than 30 [26]. Total weight loss percentage was higher in bariatric surgery patients compared to those undergoing immediate total knee arthroplasty in the SWIFT trial [27].

Ambulatory Surgical Center Selection: Body mass index greater than 40 is not correlated with early complications in patients undergoing primary total joint arthroplasty at an ambulatory surgical center [4]. 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 [4]. BMI should not serve as an exclusion criterion for primary total joint arthroplasty at ambulatory surgical centers; patient selection should be more inclusive and evidence-based [4].

Total Knee Arthroplasty (TKA): A body mass index of 45 is a safe cut-off for cementless total knee arthroplasty, though numbers were too small to draw conclusions for patients with BMI ≥ 45 [6]. Modern surgical practices and implant designs may have mitigated traditional obesity-related risks, resulting in minimal impact on loosening and mechanical failure in total knee arthroplasty [8]. Obesity remains a critical risk factor for mechanical failures in functionally aligned image-based robotic total knee arthroplasty, despite comparable functional outcomes [11]. Increasing obesity severity is not associated with higher rates of postoperative stiffness or inferior outcomes following manipulation under anesthesia after total knee arthroplasty [9]. Concern for stiffness alone should not serve as a categorical barrier to total knee arthroplasty or manipulation under anesthesia when clinically indicated [9]. 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 [17]. Specific tibial stem extension designs may benefit selected populations of obese total knee arthroplasty patients [17].

Total Hip Arthroplasty (THA): Type 2 diabetes is not associated with excess risk of periprosthetic joint infection in obese patients undergoing total hip arthroplasty [3]. Type 2 diabetes constitutes a minor risk factor for periprosthetic joint infection in individuals of normal or underweight status [3]. Obesity class does not associate with the incidence, timing, or invasiveness of reoperations after total hip arthroplasty [10]. In morbidly obese patients undergoing primary total hip arthroplasty, dual mobility implants demonstrated excellent five-year survivorship with outcomes comparable or slightly superior to fixed-bearing constructs [24].

Hip Arthroscopy: Obese and overweight patients undergoing hip arthroscopy for femoroacetabular impingement syndrome convert to total hip arthroplasty at significantly higher rates compared with normal-weight patients [7]. Patients with obesity have greater than 2-fold odds of conversion to total hip arthroplasty after hip arthroscopy for femoroacetabular impingement syndrome [23]. Multicenter data demonstrates 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 in modern hip arthroscopy patients [19].

Shoulder Arthroplasty: Obesity increases the risk of all-cause revisions and revision for instability or dislocation in patients receiving reverse total shoulder arthroplasty indicated for fractures [21].

Other Procedures: Body mass index does not affect clinical outcomes following arthroscopically assisted posterior latissimus dorsi tendon transfer for irreparable posterosuperior rotator cuff tears [2]. There are no significant differences in clinical improvements between above-average and below-average BMI groups following arthroscopically assisted posterior latissimus dorsi tendon transfer [2]. Obesity substantially lengthened length of stay and encouraged undesirable discharge when compared to non-obese individuals in pediatric lower extremity fracture surgery [20].

Key Considerations

Obesity is a systemic disease with profound inflammatory consequences on joint health, extending beyond its role as a mechanical burden on the knee [1]. While traditional concerns persist, modern surgical practices and implant designs may have mitigated obesity-related risks, resulting in minimal impact on loosening and mechanical failure in total knee arthroplasty [8].

Preoperative Risk Stratification: Type 2 Diabetes: Not associated with excess risk of periprosthetic joint infection in obese patients undergoing total hip arthroplasty [3]. It constitutes a minor risk factor for periprosthetic joint infection in individuals of normal or underweight status undergoing total hip arthroplasty [3]. BMI Thresholds: A BMI greater than 40 is not correlated with early complications in patients undergoing primary total joint arthroplasty at an ambulatory surgical center [4]. Management of preoperative comorbidities and custom surgical planning can achieve outcomes comparable to those of patients with normal BMIs at ambulatory surgical centers, questioning BMI as an exclusion criterion [4]. 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 [6]. Reoperation Risk: WHO obesity class is not associated with the risk, invasiveness, or timing of reoperations after total hip arthroplasty [10]. Ten-year functional outcomes and revision rates of total hip arthroplasty do not justify restricting access to surgery on the basis of BMI [31].

Procedure-Specific Outcomes: Shoulder Arthroplasty: Body mass index (BMI) 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 BMI groups [2]. 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 [21]. Hip Arthroplasty: Obese and overweight patients convert to total hip arthroplasty at significantly higher rates compared with normal-weight patients following hip arthroscopy for femoroacetabular impingement syndrome [7]. 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 [24]. Knee Arthroplasty: Increasing obesity severity is not associated with higher rates of postoperative stiffness or inferior outcomes following manipulation under anesthesia for total knee arthroplasty [9]. Concern for stiffness alone should not serve as a categorical barrier to total knee arthroplasty or manipulation under anesthesia when clinically indicated [9]. Obese patients are at increased risk of higher revision rates following unicompartmental knee arthroplasty [15].

Implant Selection and Revision: The current body of literature regarding tibial stem extension in total knee arthroplasty of obese patients is limited and heterogeneous, creating uncertainty rather than proving inefficacy [16]. 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 [16]. 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 [17]. Specific implant designs may benefit selected populations despite the lack of support for routine use of tibial stem extensions in obese total knee arthroplasty patients [17].

Pediatric and Arthroscopy Considerations: Obesity substantially lengthened length of stay and encouraged undesirable discharge when compared to non-obese individuals following lower extremity fracture surgery in pediatric patients [20]. Obesity and preexisting osteoarthritis are risk factors for predicting poor outcomes and conversion to arthroplasty after knee arthroscopy [14]. The study linking obesity and osteoarthritis to conversion to arthroplasty after knee arthroscopy lacks a control group and specific procedural details to determine if surgery itself drives progression versus patient factors [14].

Key Evidence

  • [L5] Obesity is more than a mechanical burden on the knee; it is a systemic disease with profound inflammatory consequences on joint health. (10.1002/arj.70051)
  • [L2] No significant differences were observed between above-average and below-average BMI groups, and BMI was not correlated with clinical improvements. (10.1016/j.xrrt.2025.100634)
  • [L2] However, T2DM constitutes a minor risk factor in individuals of normal/underweight. (10.1186/s12891-026-09568-5)
  • [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. (10.1016/j.arth.2025.08.065)
  • [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. (10.1186/s12891-026-09495-5)
  • [L3] However, the numbers were too small to draw conclusions in patients who have a BMI ≥ 45. (10.1016/j.arth.2025.12.038)
  • [L3] Obese and overweight patients converted to THA at significantly higher rates compared with normal-weight patients. (10.1177/03635465251400355)
  • [L3] These findings suggest modern surgical practices and implant designs may have mitigated traditional obesity-related risks. (10.1016/j.arth.2026.04.031)
  • [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. (10.1016/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. (10.1016/j.arth.2025.07.026)
  • [L3] However, obesity remains a critical risk factor for mechanical failures. (10.1016/j.jisako.2025.100861)
  • [L2] Central obesity is significantly associated with the risk of glenohumeral joint osteoarthritis, especially in secondary GJO and normal BMI populations, suggesting that fat distribution should be included in the early screening and risk assessment system for GJO. (10.1016/j.jse.2025.07.007)
  • [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. (10.1016/j.jisako.2025.100927)
  • [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. (10.1016/j.arthro.2025.04.036)
  • [L3] Based on AOANJRR data, obese patients are at increased risk of higher rate of revision following UKA. (10.1177/2325967125s00336)
  • [L5] The current body of literature is limited and heterogeneous, creating 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. (10.1016/j.arth.2025.11.047)
  • [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. (10.1016/j.arth.2025.11.056)
  • [L3] Otherwise, the complication profile was similar across the spectrum of BMI values. (10.1016/j.arth.2026.01.024)
  • [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. (10.1002/ksa.12745)
  • [L4] Obesity substantially lengthened length of stay and encouraged undesirable discharge when compared to non-obese individuals. (10.1186/s12891-025-09349-6)
  • [L3] Obesity has an increased risk of all-cause revisions and revision for instability or dislocation in patients receiving rTSA indicated for fractures. (10.1016/j.jse.2025.05.036)
  • [L3] BMI has a weak-to-moderate association with peri-incisional adiposity in primary total joint arthroplasty patients. (10.1016/j.arth.2024.08.020)
  • [L3] However, patients with obesity had >2-fold odds of conversion to THA. (10.1177/03635465251392585)
  • [L3] In morbidly obese patients, DM implants demonstrated excellent five-year survivorship with outcomes comparable or slightly superior to fixed-bearing constructs. (10.1016/j.arth.2026.03.075)
  • [L3] Semaglutide appears to be a safe alternative to bariatric surgery for weight management before THA, with similar implant survival and postoperative complication rates. (10.1016/j.arth.2025.08.068)
  • [L3] Our findings support a BMI-based approach to perioperative semaglutide use, particularly in patients who have a BMI >30. (10.1016/j.arth.2025.09.056)
  • [L1] Total weight loss % was higher in bariatric surgery patients (28.7%, P < 0.001). (10.1016/j.arth.2026.05.033)
  • [Letter] Effective OA management during conservative and postsurgical phases must integrate mechanical, metabolic, and immunological insight to provide personalized joint preservation strategies. (10.1002/arj.70057)
  • [L1] Following MMPRT repair, repairs show progression of osteoarthritis with higher rates seen with elevated BMI. (10.1002/arj.70028)
  • [L3] The ten-year functional outcomes and revision rates of THA do not justify restricting access to surgery on the basis of BMI. (10.1016/j.arth.2025.07.044)

References

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

[2] 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

[3] 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

[4] 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

[5] 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

[6] 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

[7] 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

[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] 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

[10] 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

[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] Association between central obesity and the risk of glenohumeral joint osteoarthritis: a prospective study. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2025.07.007

[13] 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

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

[16] 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.2025.11.047

[17] 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

[18] Rising Body Mass Index Increased Early Complications, But Not Early Reoperations Following Aseptic Revision Total Knee Arthroplasty. The Journal of Arthroplasty. 2026. DOI: 10.1016/j.arth.2026.01.024

[19] 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

[20] 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

[21] 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

[22] 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

[23] 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

[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] 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

[26] 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

[27] 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

[28] Author Reply to “Reframing Obesity in Knee Osteoarthritis: A Call for a Transdisciplinary Approach Beyond Biomechanics”. Arthroscopy. 2026. DOI: 10.1002/arj.70057

[29] 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

[31] 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

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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.