{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T02:32:40Z","timestamp":1765247560651,"version":"3.46.0"},"reference-count":27,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2025,10,25]],"date-time":"2025-10-25T00:00:00Z","timestamp":1761350400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100012166","name":"National Key Research and Development Program of China","doi-asserted-by":"publisher","award":["2022YFC2503100","2022YFC2503104","2022YFC2503103"],"award-info":[{"award-number":["2022YFC2503100","2022YFC2503104","2022YFC2503103"]}],"id":[{"id":"10.13039\/501100012166","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Surgery"],"published-print":{"date-parts":[[2025,12]]},"abstract":"ABSTRACT<\/jats:title>\n \n Objectives<\/jats:title>\n \n Obesity has an important impact on the future of total joint arthroplasty (\n TKA<\/jats:styled-content>\n ). We aimed to determine whether waist\u2010to\u2010hip ratio (\n WHR<\/jats:styled-content>\n ) is a useful measurement in predicting postoperative outcomes associated with obesity in patients undergoing primary\n TKA<\/jats:styled-content>\n and compared the predictive value of\n WHR<\/jats:styled-content>\n to that of body mass index (\n BMI<\/jats:styled-content>\n ).\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n Prospective data from patients undergoing unilateral primary\n TKA<\/jats:styled-content>\n from February to May 2024 were analyzed, including\n BMI<\/jats:styled-content>\n and\n WHR<\/jats:styled-content>\n . Outcomes included complications, hospitalization details, and 12\u2010month patient\u2010reported function (University of California, Los Angeles [\n UCLA<\/jats:styled-content>\n ] activity scale, the Hospital for Special Surgery [\n HSS<\/jats:styled-content>\n ] score). Multivariable regression models were used to identify significant obesity\u2010related predictors of outcomes.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 195 patients were included, with the mean\n BMI<\/jats:styled-content>\n of 28.2\u2009\u00b1\u20095.2\u2009kg\/m\n 2<\/jats:sup>\n (range: 17.6\u201340.8) and the mean\n WHR<\/jats:styled-content>\n of 1.03\u2009\u00b1\u20090.08 (range: 0.83\u20131.27).\n WHR<\/jats:styled-content>\n was a significant predictor of wound complication (\n OR<\/jats:styled-content>\n : 1.087,\n p<\/jats:italic>\n \u2009=\u20090.016). Both\n WHR<\/jats:styled-content>\n (\n OR<\/jats:styled-content>\n : 1.153,\n p<\/jats:italic>\n \u2009=\u20090.004) and\n BMI<\/jats:styled-content>\n (\n OR<\/jats:styled-content>\n : 1.058,\n p<\/jats:italic>\n \u2009=\u20090.021) independently predicted systemic complications, with\n WHR<\/jats:styled-content>\n explaining greater variance (\n \n R<\/jats:italic>\n 2<\/jats:sup>\n <\/jats:styled-content>\n \u2009=\u20090.241 vs. 0.107 for\n BMI<\/jats:styled-content>\n ). For functional outcomes, higher\n WHR<\/jats:styled-content>\n was associated with poorer\n UCLA<\/jats:styled-content>\n activity scores (\n RR<\/jats:styled-content>\n : 0.877,\n p<\/jats:italic>\n \u2009=\u20090.012) and\n HSS<\/jats:styled-content>\n function scores (\n RR<\/jats:styled-content>\n : 0.921,\n p<\/jats:italic>\n \u2009<\u20090.001), whereas\n BMI<\/jats:styled-content>\n only showed significance for\n HSS<\/jats:styled-content>\n function scores (\n RR<\/jats:styled-content>\n : 0.960,\n p<\/jats:italic>\n \u2009=\u20090.002).\n WHR<\/jats:styled-content>\n again explained more variance in\n HSS<\/jats:styled-content>\n function scores (\n \n R<\/jats:italic>\n 2<\/jats:sup>\n <\/jats:styled-content>\n \u2009=\u20090.233 vs. 0.124). In contrast, neither\n WHR<\/jats:styled-content>\n nor\n BMI<\/jats:styled-content>\n correlated with surgical records, hospitalization days, or\n HSS<\/jats:styled-content>\n pain scores (all\n p<\/jats:italic>\n \u2009>\u20090.05).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n The\n WHR<\/jats:styled-content>\n demonstrates superior predictive value over\n BMI<\/jats:styled-content>\n for perioperative complications and 12\u2010month patient\u2010reported functional outcomes following primary\n TKA<\/jats:styled-content>\n . Preoperative\n WHR<\/jats:styled-content>\n assessment may help surgeons improve risk stratification and better educate obese patients regarding postoperative expectations prior to elective\n TKA<\/jats:styled-content>\n .\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/os.70201","type":"journal-article","created":{"date-parts":[[2025,10,25]],"date-time":"2025-10-25T12:30:16Z","timestamp":1761395416000},"page":"3495-3501","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Waist\u2010To\u2010Hip Ratio Is More Predictive of Patients\u2010Reported Outcomes After Total Joint Arthroplasty Than Body Mass Index: A Prospective Cohort Study"],"prefix":"10.1111","volume":"17","author":[{"given":"Long","family":"Zhao","sequence":"first","affiliation":[{"name":"Department of Orthopedics and Orthopedic Research Institute West China Hospital, Sichuan University Chengdu People's Republic of China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yinghao","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Orthopedic Research Institute West China Hospital, Sichuan University Chengdu People's Republic of China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Duan","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Orthopedic Research Institute West China Hospital, Sichuan University Chengdu People's Republic of China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9037-4756","authenticated-orcid":false,"given":"Zongke","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Orthopedic Research Institute West China Hospital, Sichuan University Chengdu People's Republic of China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,10,25]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(23)02750\u20102"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/os.14040"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/os.13809"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2013.02.011"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.16.00960315"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2016.05.071"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2024.04.011"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/s42836\u2010022\u201000149\u20100"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.3760\/cma.J.c.n115610\u201020241017\u201000455"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1038\/d41586\u2010023\u201003143\u2010x"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2010.02.006"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1055\/s\u20100037\u20101608933"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.34836"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11999\u2010008\u20100358\u20105"},{"issue":"6","key":"e_1_2_13_16_1","first-page":"627","article-title":"Comparative 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