ArticleArthroplasty (London, England)2026
Does weight gain from time of indication to date of surgery affect outcomes in total knee arthroplasty?
Article in Arthroplasty (London, England), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe impact of body mass index (BMI) on outcomes after total knee arthroplasty (TKA) is a highly debated topic. Our study aims to investigate the implications of BMI changes from the day of surgical booking to the surgery date on perioperative and postoperative outcomes.
methodsWe retrospectively reviewed patients who underwent elective, primary, unilateral TKA at an urban academic institution from 2015-2024 with a minimum 90-day follow-up. The cohort was classified into three groups by percent BMI change from surgical booking date to TKA date: Group 1, decrease in BMI; Group 2, 0-5% increase in BMI; and Group 3, > 5% increase in BMI. Propensity-score matching (1:1:1) based on age, gender, BMI at surgical booking, and smoking status was performed; perioperative and postoperative outcomes were compared. Multivariate regression analysis evaluated risk factors for interval change in BMI.
resultsBefore matching, 12,990 patients were included, with 39.6% in Group 1, 41.2% in Group 2, and the remaining 19.2% in Group 3. Notably, Group 3 had the longest length of stay (50.3 h vs. 48.6 [1] & 47.1 [2]; P = 0.002) and the lowest discharge-to-home rates (88.7% vs. 89.8% [1] & 91.7% [2]; P = 0.014). No significant difference was seen in 90-day ED visits, 90-day readmissions, or revision rates. Logistic regression of the pre-match cohort found that prolonged surgical booking delays were associated with decreased all-cause revisions (OR = 0.98; P = 0.038), while percent BMI change in this period did not impact revision incidence. Duration of surgical booking delay had no impact on BMI changes in obese patients.
conclusionOur study evaluated preoperative BMI change between surgical booking and TKA, finding that most patients (60.4%) gain weight during this time. While patients with significant BMI increases (> 5%) had longer hospital stays and lower discharge-to-home rates, Percent BMI change during this period did not impact all-cause or septic revision incidence.
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