{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T08:10:38Z","timestamp":1793261438917,"version":"4.5.0"},"reference-count":51,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,7,24]],"date-time":"2021-07-24T00:00:00Z","timestamp":1627084800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,7,24]],"date-time":"2021-07-24T00:00:00Z","timestamp":1627084800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Musculoskelet Disord"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Total knee arthroplasty is known to successfully alleviate pain and improve function in endstage knee osteoarthritis. However, there is some controversy with regard to the influence of obesity on clinical benefits after TKA. The aim of this study was to investigate the impact of body mass index (BMI) on improvement in pain, function and general health status following total knee arthroplasty (TKA).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>A single-centre retrospective analysis of primary TKAs performed between 2006 and 2016 was performed. Data were collected preoperatively and 12-month postoperatively using WOMAC score and EQ-5D. Longitudinal score change was compared across the BMI categories identified by the World Health Organization.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Data from 1565 patients [mean age 69.1, 62.2% women] were accessed. Weight distribution was: 21.2% BMI\u2009&lt;\u200925.0\u00a0kg\/m<jats:sup>2<\/jats:sup>, 36.9% BMI 25.0\u201329.9\u00a0kg\/m<jats:sup>2<\/jats:sup>, 27.0% BMI 30.0\u201334.9\u00a0kg\/m<jats:sup>2<\/jats:sup>, 10.2% BMI 35.0\u201339.9\u00a0kg\/m<jats:sup>2<\/jats:sup>, and 4.6% BMI\u2009\u2265\u200940.0\u00a0kg\/m<jats:sup>2<\/jats:sup>. All outcome measures improved between preoperative and 12-month follow-up (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). In pairwise comparisons against normal weight patients, patients with class I-II obesity showed larger improvement on the WOMAC function and total score. For WOMAC pain improvements were larger for all three obesity classes.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Post-operative improvement in joint-specific outcomes was larger in obese patients compared to normal weight patients. These findings suggest that obese patients may have the greatest benefits from TKA with regard to function and pain relief one year post-op. Well balanced treatment decisions should fully account for both: Higher benefits in terms of pain relief and function as well as increased potential risks and complications.<\/jats:p>\n                <jats:p>Trial registration<\/jats:p>\n                <jats:p>This trial has been registered with the ethics committee of Eastern Switzerland (EKOS; Project-ID: EKOS 2020\u201300,879)<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12891-021-04512-1","type":"journal-article","created":{"date-parts":[[2021,7,24]],"date-time":"2021-07-24T14:02:31Z","timestamp":1627135351000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":37,"title":["Higher body mass index is associated with larger postoperative improvement in patient-reported outcomes following total knee arthroplasty"],"prefix":"10.1186","volume":"22","author":[{"given":"K","family":"Giesinger","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JM","family":"Giesinger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"DF","family":"Hamilton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Rechsteiner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Ladurner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,7,24]]},"reference":[{"key":"4512_CR1","doi-asserted-by":"crossref","unstructured":"Neogi T. The epidemiology and impact of pain in osteoarthritis. Osteoarthr Cartil. 2013;21(9):1145\u201353. [cited 2020 Apr 14] Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23973124","DOI":"10.1016\/j.joca.2013.03.018"},{"key":"4512_CR2","doi-asserted-by":"crossref","unstructured":"Feng JE, Novikov D, Anoushiravani AA, Schwarzkopf R. Total knee arthroplasty: Improving outcomes with a multidisciplinary approach. J Multidisciplinary Healthcare.\u00a02018;11:63\u201373.","DOI":"10.2147\/JMDH.S140550"},{"key":"4512_CR3","doi-asserted-by":"crossref","unstructured":"Hamilton D, Henderson GR, Gaston P, MacDonald D, Howie C, Simpson AHRW. Comparative outcomes of total hip and knee arthroplasty: A prospective cohort study. Postgrad Med J. 2012;88(1045):627\u201331. [cited 2020 Aug 29] Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/22822221\/","DOI":"10.1136\/postgradmedj-2011-130715"},{"key":"4512_CR4","unstructured":"National Joint Registry 15th Annual Report 2018 \u2013 HQIP. [cited 2020 Aug 29]. Available from: https:\/\/www.hqip.org.uk\/resource\/national-joint-registry-15th-annual-report-2018\/#.X0o-aNMzbuw"},{"key":"4512_CR5","doi-asserted-by":"crossref","unstructured":"Cram P, Lu X, Kates SL, Singh JA, Li Y, Wolf BR. Total knee arthroplasty volume, utilization, and outcomes among medicare beneficiaries, 1991\u20132010. JAMA - J Am Med Assoc. 2012;308(12):1227\u201336. [cited 2020 Aug 29] Available from: www.jama.com.","DOI":"10.1001\/2012.jama.11153"},{"key":"4512_CR6","doi-asserted-by":"publisher","unstructured":"Boyce L, Prasad A, Barrett M, Dawson-Bowling S, Millington S, Hanna SA, et al. The outcomes of total knee arthroplasty in morbidly obese patients: a systematic review of the literature. Arch Orthopaedic Trauma Surg. 2019;139:553\u201360. [cited 2020 Apr 13] Available from: https:\/\/doi.org\/10.1007\/s00402-019-03127-5","DOI":"10.1007\/s00402-019-03127-5"},{"issue":"1","key":"4512_CR7","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1055\/s-0039-1678563","volume":"7","author":"DE Bonasia","year":"2019","unstructured":"Bonasia DE, Palazzolo A, Cottino U, Saccia F, Mazzola C, Rosso F, et al. Modifiable and nonmodifiable predictive factors associated with the outcomes of total knee arthroplasty. Joints. 2019;7(1):13\u20138.","journal-title":"Joints"},{"issue":"5","key":"4512_CR8","doi-asserted-by":"publisher","first-page":"579","DOI":"10.1302\/0301-620X.100B5.BJJ-2017-1263.R1","volume":"100B","author":"S Xu","year":"2018","unstructured":"Xu S, Chen JY, Lo NN, Chia SL, Tay DKJ, Pang HN, et al. The influence of obesity on functional outcome and quality of life after total knee arthroplasty. Bone Jt J. 2018;100B(5):579\u201383.","journal-title":"Bone Jt J"},{"key":"4512_CR9","doi-asserted-by":"crossref","unstructured":"Keeney BJ, Austin DC, Jevsevar DS. Preoperative Weight Loss for Morbidly Obese Patients Undergoing Total Knee Arthroplasty: Determining the Necessary Amount. J Bone Jt Surg - Am Vol. 2019;101(16):1440\u201350. [cited 2021 Mar 31] Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/31436651\/","DOI":"10.2106\/JBJS.18.01136"},{"key":"4512_CR10","doi-asserted-by":"crossref","unstructured":"Martin JR, Jennings JM, Dennis DA. Morbid obesity and total knee arthroplasty: A growing problem. Vol. 25, Journal of the American Academy of Orthopaedic Surgeons. Lippincott Williams and Wilkins; 2017; 188\u201394. [cited 2020 Apr 13] Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/28146438","DOI":"10.5435\/JAAOS-D-15-00684"},{"key":"4512_CR11","doi-asserted-by":"crossref","unstructured":"Gandhi R, Wasserstein D, Razak F, Davey JR, Mahomed NN. BMI independently predicts younger age at hip and knee replacement. Obesity. 2010;18(12):2362\u20136. [cited 2020 Apr 10] Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20379147","DOI":"10.1038\/oby.2010.72"},{"key":"4512_CR12","doi-asserted-by":"crossref","unstructured":"Di Cesare M, Bentham J, Stevens GA, Zhou B, Danaei G, Lu Y, et al. Trends in adult body-mass index in 200 countries from 1975 to 2014: A pooled analysis of 1698 population-based measurement studies with 19.2 million participants. Lancet. 2016 Apr 2;387(10026):1377\u201396.","DOI":"10.1016\/S0140-6736(16)30054-X"},{"key":"4512_CR13","doi-asserted-by":"crossref","unstructured":"Uccioli L, Monticone G, Russo F, Mormile F, Durola L, Mennuni G, et al. OBESITY: PREVENTING AND MANAGING THE GLOBAL EPIDEMIC. WHO Tech Rep Ser. 1994;37(10):1051\u20135. [cited 2020 Apr 7] Available from: https:\/\/www.who.int\/nutrition\/publications\/obesity\/WHO_TRS_894\/en\/","DOI":"10.1007\/s001250050216"},{"issue":"9765","key":"4512_CR14","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1016\/S0140-6736(10)62037-5","volume":"377","author":"MM Finucane","year":"2011","unstructured":"Finucane MM, Stevens GA, Cowan MJ, Danaei G, Lin JK, Paciorek CJ, et al. National, regional, and global trends in body-mass index since 1980: Systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9\u00b71 million participants. Lancet. 2011;377(9765):557\u201367.","journal-title":"Lancet"},{"key":"4512_CR15","doi-asserted-by":"crossref","unstructured":"Wang Y, Chen X. How Much of Racial\/Ethnic Disparities in Dietary Intakes, Exercise, and Weight Status Can Be Explained by Nutrition- and Health-Related Psychosocial Factors and Socioeconomic Status among US Adults? J Am Diet Assoc. 2011;111(12):1904\u201311. [cited 2020 Aug 29] Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/22117667\/","DOI":"10.1016\/j.jada.2011.09.036"},{"key":"4512_CR16","doi-asserted-by":"crossref","unstructured":"Si H bo, Zeng Y, Shen B, Yang J, Zhou Z ke, Kang P de, et al. The influence of body mass index on the outcomes of primary total knee arthroplasty. Vol. 23, Knee Surgery, Sports Traumatology, Arthroscopy. Springer Verlag; 2015; 1824\u201332. [cited 2020 Apr 14] Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25217315","DOI":"10.1007\/s00167-014-3301-1"},{"key":"4512_CR17","doi-asserted-by":"crossref","unstructured":"Chen JY, Lo NN, Chong HC, Bin Abd Razak HR, Pang HN, Tay DKJ, et al. The influence of body mass index on functional outcome and quality of life after total knee arthroplasty. Bone Jt J. 2016;98-B(6):780\u20135. [cited 2020 Apr 13] Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/27235520","DOI":"10.1302\/0301-620X.98B6.35709"},{"key":"4512_CR18","doi-asserted-by":"crossref","unstructured":"Abdel MP, Bonadurer GF, Jennings MT, Hanssen AD. Increased Aseptic Tibial Failures in Patients With a BMI \u226535 and Well-Aligned Total Knee Arthroplasties. J Arthroplasty. 2015;30(12):2181\u20134. [cited 2020 Apr 13] Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/26220103","DOI":"10.1016\/j.arth.2015.06.057"},{"key":"4512_CR19","doi-asserted-by":"crossref","unstructured":"Baker P, Petheram T, Jameson S, Reed M, Gregg P, Deehan D. The association between body mass index and the outcomes of total knee arthroplasty. J Bone Joint Surg Am. 2012;94(16):1501\u20138. [cited 2020 Apr 13] Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22992819","DOI":"10.2106\/JBJS.K.01180"},{"key":"4512_CR20","doi-asserted-by":"publisher","unstructured":"Kerkhoffs GMMJ, Servien E, Dunn W, Dahm D, Bramer JAM, Haverkamp D. The influence of obesity on the complication rate and outcome of total knee arthroplasty: A meta-analysis and systematic literature review. J Bone Jt Surg - Ser A. 2012;94(20):1839\u201344. [cited 2020 Apr 13] Available from: http:\/\/dx.doi.org\/https:\/\/doi.org\/10.2106\/JBJS.K.00820","DOI":"10.2106\/JBJS.K.00820"},{"key":"4512_CR21","doi-asserted-by":"crossref","unstructured":"Rissman CM, Keeney BJ, Ercolano EM, Koenig KM. Predictors of Facility Discharge, Range of Motion, and Patient-Reported Physical Function Improvement After Primary Total Knee Arthroplasty: A Prospective Cohort Analysis. J Arthroplasty. 2016;31(1):36\u201341. [cited 2021 Mar 31] Available from: \/pmc\/articles\/PMC4691374\/","DOI":"10.1016\/j.arth.2015.09.002"},{"key":"4512_CR22","doi-asserted-by":"crossref","unstructured":"D\u2019Apuzzo MR, Novicoff WM, Browne JA. The John Insall Award: Morbid Obesity Independently Impacts Complications, Mortality, and Resource Use After TKA. Clin Orthop Relat Res. 2015;473(1):57\u201363. [cited 2021 Mar 31] Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/24818736\/","DOI":"10.1007\/s11999-014-3668-9"},{"key":"4512_CR23","doi-asserted-by":"crossref","unstructured":"Sun K, Li H. Body mass index as a predictor of outcome in total knee replace: A systemic review and meta-analysis. Knee. 2017;24(5):917\u201324. [cited 2020 Aug 29] Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/28666646\/","DOI":"10.1016\/j.knee.2017.05.022"},{"key":"4512_CR24","doi-asserted-by":"crossref","unstructured":"Adhikary SD, Liu WM, Memtsoudis SG, Davis CM, Liu J. Body Mass Index More Than 45 kg\/m2 as a Cutoff Point Is Associated With Dramatically Increased Postoperative Complications in Total Knee Arthroplasty and Total Hip Arthroplasty. J Arthroplasty. 2016;31(4):749\u201353. [cited 2020 Apr 14] Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/26652477","DOI":"10.1016\/j.arth.2015.10.042"},{"key":"4512_CR25","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1186\/1471-2474-10-29","volume":"10","author":"B Bordini","year":"2009","unstructured":"Bordini B, Stea S, Cremonini S, Viceconti M, De Palma R, Toni A. Relationship between obesity and early failure of total knee prostheses. BMC Musculoskelet Disord. 2009;10:29.","journal-title":"BMC Musculoskelet Disord"},{"key":"4512_CR26","doi-asserted-by":"crossref","unstructured":"Keeney BJ, Koenig KM, Paddock NG, Moschetti WE, Sparks MB, Jevsevar DS. Do Aggregate Socioeconomic Status Factors Predict Outcomes for Total Knee Arthroplasty in a Rural Population? J Arthroplasty. 2017;32(12):3583\u201390. [cited 2021 Mar 31] Available from: \/pmc\/articles\/PMC5693700\/","DOI":"10.1016\/j.arth.2017.07.002"},{"key":"4512_CR27","doi-asserted-by":"crossref","unstructured":"Li W, Ayers DC, Lewis CG, Bowen TR, Allison JJ, Franklin PD. Functional Gain and Pain Relief after Total Joint Replacement According to Obesity Status. J Bone Jt Surg - Am Vol. 2017;99(14):1183\u20139. [cited 2020 Aug 29] Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/28719557\/","DOI":"10.2106\/JBJS.16.00960"},{"key":"4512_CR28","doi-asserted-by":"crossref","unstructured":"Collins JE, Donnell-Fink LA, Yang HY, Usiskin IM, Lape EC, Wright J, et al. Effect of Obesity on Pain and Functional Recovery Following Total Knee Arthroplasty. J Bone Joint Surg Am. 2017;99(21):1812\u20138. [cited 2020 Aug 29] Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/29088035\/","DOI":"10.2106\/JBJS.17.00022"},{"key":"4512_CR29","doi-asserted-by":"crossref","unstructured":"Giesinger JM, Loth FL, MacDonald DJ, Giesinger K, Patton JT, Simpson AHRW, et al. Patient-reported outcome metrics following total knee arthroplasty are influenced differently by patients\u2019 body mass index. Knee Surgery, Sport Traumatol Arthrosc. 2018;26(11):3257\u201364. [cited 2020 Apr 14] Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/29417168","DOI":"10.1007\/s00167-018-4853-2"},{"key":"4512_CR30","unstructured":"Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15(12):1833\u201340. [cited 2018 Jul 16] Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/3068365"},{"issue":"4","key":"4512_CR31","doi-asserted-by":"publisher","first-page":"384","DOI":"10.1002\/1529-0131(200108)45:4<384::AID-ART352>3.0.CO;2-0","volume":"45","author":"F Angst","year":"2001","unstructured":"Angst F, Aeschlimann A, Stucki G. Smallest detectable and minimal clinically important differences of rehabilitation intervention with their implications for required sample sizes using WOMAC and SF-36 quality of life measurement instruments in patients with osteoarthritis of the lower ex. Arthritis Rheum. 2001;45(4):384\u201391.","journal-title":"Arthritis Rheum"},{"key":"4512_CR32","doi-asserted-by":"crossref","unstructured":"The EuroQol Group. EuroQol - a new facility for the measurement of health-related quality of life. Health Policy (New York). 1990;16(3):199\u2013208.","DOI":"10.1016\/0168-8510(90)90421-9"},{"key":"4512_CR33","doi-asserted-by":"crossref","unstructured":"Conner-Spady BL, Marshall DA, Bohm E, Dunbar MJ, Loucks L, Khudairy A Al, et al. Reliability and validity of the EQ-5D-5L compared to the EQ-5D-3L in patients with osteoarthritis referred for hip and knee replacement. Qual Life Res. 2015;24(7):1775\u201384. [cited 2020 Apr 7] Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25555837","DOI":"10.1007\/s11136-014-0910-6"},{"key":"4512_CR34","doi-asserted-by":"crossref","unstructured":"Amin AK, Clayton RAE, Patton JT, Gaston M, Cook RE, Brenkel IJ. Total knee replacement in morbidly obese patients: Results of a prospective, matched study. J Bone Jt Surg - Ser B. 2006;88(10):1321\u20136. [cited 2020 Apr 13] Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17012421","DOI":"10.1302\/0301-620X.88B10.17697"},{"issue":"1","key":"4512_CR35","doi-asserted-by":"publisher","first-page":"594","DOI":"10.2174\/1874325001307010594","volume":"7","author":"H Lash","year":"2013","unstructured":"Lash H, Hooper G, Hooper N, Frampton C. Should a Patients BMI Status be Used to Restrict Access to Total Hip and Knee Arthroplasty? Functional Outcomes of Arthroplasty Relative to BMI - Single Centre Retrospective Review. Open Orthop J. 2013;7(1):594\u20139.","journal-title":"Open Orthop J"},{"key":"4512_CR36","doi-asserted-by":"crossref","unstructured":"Dewan A, Bertolusso R, Karastinos A, Conditt M, Noble PC, Parsley BS. Implant Durability and Knee Function After Total Knee Arthroplasty in the Morbidly Obese Patient. J Arthroplasty. 2009;24(6 SUPPL.):89\u201394, 94.e1\u20133. [cited 2020 Apr 13] Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19576727","DOI":"10.1016\/j.arth.2009.04.024"},{"key":"4512_CR37","doi-asserted-by":"crossref","unstructured":"Werner BC, Evans CL, Carothers JT, Browne JA. Primary Total Knee Arthroplasty in Super-obese Patients: Dramatically Higher Postoperative Complication Rates Even Compared to Revision Surgery. J Arthroplasty. 2015;30(5):849\u201353. [cited 2020 Apr 13] Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25577726","DOI":"10.1016\/j.arth.2014.12.016"},{"key":"4512_CR38","doi-asserted-by":"crossref","unstructured":"Naziri Q, Issa K, Malkani AL, Bonutti PM, Harwin SF, Mont MA. Bariatric orthopaedics: Total knee arthroplasty in super-obese patients (BMI > 50 kg\/m 2 ). Survivorship and complications. Clin Orthop Relat Res. 2013;471(11):3523\u201330.","DOI":"10.1007\/s11999-013-3154-9"},{"key":"4512_CR39","doi-asserted-by":"crossref","unstructured":"Krushell RJ, Fingeroth RJ. Primary Total Knee Arthroplasty in Morbidly Obese Patients. A 5- to 14-Year Follow-up Study. J Arthroplasty. 2007;22(6 SUPPL.):77\u201380. [cited 2020 Apr 13] Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17823021","DOI":"10.1016\/j.arth.2007.03.024"},{"key":"4512_CR40","doi-asserted-by":"crossref","unstructured":"Jia H, Zack MM, Thompson WW. Population-based estimates of decreases in quality-adjusted life expectancy associated with unhealthy body mass index. Public Health Rep. 2016;131(1):177\u201384. [cited 2020 Jun 20] Available from: \/pmc\/articles\/PMC4716486\/?report=abstract","DOI":"10.1177\/003335491613100125"},{"key":"4512_CR41","doi-asserted-by":"crossref","unstructured":"Lung T, Jan S, Tan EJ, Killedar A, Hayes A. Impact of overweight, obesity and severe obesity on life expectancy of Australian adults. Int J Obes. 2019;43(4):782\u20139. [cited 2020 Jun 20] Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/30283076\/","DOI":"10.1038\/s41366-018-0210-2"},{"key":"4512_CR42","doi-asserted-by":"crossref","unstructured":"Finkelstein EA, Brown DS, Wrage LA, Allaire BT, Hoerger TJ. Individual and aggregate years-of-life-lost associated with overweight and obesity. Obesity (Silver Spring). 2010;18(2):333\u20139. [cited 2020 Jun 20] Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19680230","DOI":"10.1038\/oby.2009.253"},{"key":"4512_CR43","doi-asserted-by":"crossref","unstructured":"MacMahon S, Baigent C, Duffy S, Rodgers A, Tominaga S, Chambless L, et al. Body-mass index and cause-specific mortality in 900 000 adults: Collaborative analyses of 57 prospective studies. Lancet. 2009;373(9669):1083\u201396. [cited 2020 Aug 29] Available from: http:\/\/www.ctsu.","DOI":"10.1016\/S0140-6736(09)60318-4"},{"key":"4512_CR44","doi-asserted-by":"crossref","unstructured":"Khan SS, Ning H, Wilkins JT, Allen N, Carnethon M, Berry JD, et al. Association of body mass index with lifetime risk of cardiovascular disease and compression of morbidity. JAMA Cardiol. 2018;3(4):280\u20137. [cited 2020 Aug 29] Available from: \/pmc\/articles\/PMC5875319\/?report=abstract","DOI":"10.1001\/jamacardio.2018.0022"},{"key":"4512_CR45","doi-asserted-by":"crossref","unstructured":"Bhaskaran K, Dos-Santos-Silva I, Leon DA, Douglas IJ, Smeeth L. Association of BMI with overall and cause-specific mortality: a population-based cohort study of 3\u00b76 million adults in the UK. Lancet Diabetes Endocrinol. 2018;6(12):944\u201353. [cited 2020 Aug 29] Available from: www.thelancet.com\/diabetes-endocrinology","DOI":"10.1016\/S2213-8587(18)30288-2"},{"key":"4512_CR46","doi-asserted-by":"crossref","unstructured":"Losina E, Walensky RP, Kessler CL, Emrani PS, Reichmann WM, Wright EA, et al. Cost-effectiveness of total knee arthroplasty in the United States: Patient risk and hospital volume. Arch Intern Med. 2009;169(12):1113\u201321. [cited 2020 Apr 13] Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19546411","DOI":"10.1001\/archinternmed.2009.136"},{"issue":"3","key":"4512_CR47","doi-asserted-by":"publisher","first-page":"360","DOI":"10.1302\/0301-620X.90B3.19782","volume":"90","author":"M Changulani","year":"2008","unstructured":"Changulani M, Kalairajah Y, Peel T, Field RE. The relationship between obesity and the age at which hip and knee replacement is undertaken. J Bone Jt Surg - Ser B. 2008;90(3):360\u20133.","journal-title":"J Bone Jt Surg - Ser B"},{"key":"4512_CR48","doi-asserted-by":"crossref","unstructured":"Ast MP, Abdel MP, Lee Y, Lyman S, Ruel A V., Westrich GH. Weight Changes After Total Hip or Knee Arthroplasty. J Bone Jt Surg. 2015;97(11):911\u20139. [cited 2021 Mar 31] Available from: https:\/\/journals.lww.com\/00004623-201506030-00005","DOI":"10.2106\/JBJS.N.00232"},{"key":"4512_CR49","doi-asserted-by":"crossref","unstructured":"Razzaki T, Mak WK, Bin Abd Razak HR, Tan HCA. Patterns of Weight Change and Their Effects on Clinical Outcomes Following Total Knee Arthroplasty in an Asian Population. J Arthroplasty. 2020;35(2):375\u20139. [cited 2020 Apr 14] Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/31563395","DOI":"10.1016\/j.arth.2019.09.003"},{"key":"4512_CR50","doi-asserted-by":"crossref","unstructured":"Schwartsmann CR, Borges AM, Freitas GLS de, Migon EZ, Oliveira GK de, Rodrigues MW. Do patients lose weight after total knee replacement? Rev Bras Ortop (English Ed. 2017;52(2):159\u201363. [cited 2020 Apr 14] Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/28409132","DOI":"10.1016\/j.rboe.2017.01.003"},{"key":"4512_CR51","doi-asserted-by":"crossref","unstructured":"Kandil A, Novicoff WM, Browne JA. Obesity and total joint arthroplasty: Do patients lose weight following surgery? Phys Sportsmed. 2013;41(2):34\u20137. [cited 2020 Apr 14] Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23703515","DOI":"10.3810\/psm.2013.05.2010"}],"container-title":["BMC Musculoskeletal Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12891-021-04512-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12891-021-04512-1\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12891-021-04512-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,7,24]],"date-time":"2021-07-24T14:04:50Z","timestamp":1627135490000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcmusculoskeletdisord.biomedcentral.com\/articles\/10.1186\/s12891-021-04512-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,24]]},"references-count":51,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["4512"],"URL":"https:\/\/doi.org\/10.1186\/s12891-021-04512-1","relation":{},"ISSN":["1471-2474"],"issn-type":[{"value":"1471-2474","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,7,24]]},"assertion":[{"value":"24 November 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 July 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 July 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Ethics approval for this study was obtained from the Ethics Committee of Eastern Switzerland EKOS (Ethikkommission Ostschweiz; trial registration number 2020\u201300879 from 16.04.2020). All methods were carried out in accordance with relevant guidelines and regulations.All patients provided informed consent to take part in the study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"All patients provided informed consent to take part in the study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"DH reports research support from Stryker and to have held paid presentations for the same company. The other authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"635"}}