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Although patients with very high body–mass index (BMI) have excess risk for complications after total knee arthroplasty (TKA), a recent guideline discourages “use of absolute BMI or rigid thresholds” that would prohibit surgery (NEJM JW Gen Med Dec 1 2023 and Arthritis Care Res (Hoboken) 2023; 75:2227). In this retrospective study of 10,000 Canadian patients (68% with BMI ≥30 kg/m2) who underwent TKA for degenerative arthritis, researchers evaluated outcomes between patients with severe obesity (BMI ≥50 kg/m2) and patients in lower weight groups. Mean follow-up was 8.6 years.
During the first year following TKA, risk for TKA revision among patients with BMI ≥50 kg/m2 was significantly higher than risk among patients with overweight (BMI 25.0…