{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:41:24Z","timestamp":1787755284920,"version":"build-2784847793"},"reference-count":31,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"21","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Journal of Bone and Joint Surgery"],"published-print":{"date-parts":[[2018,11,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Increasing body mass index (BMI) has been shown to correlate with increased rates of complications after total knee arthroplasty. To our knowledge, body surface area, body mass, and height have not been investigated in this manner. BMI and body surface area are affected differently by changes in height, and they are affected similarly by changes in weight. The purpose of this study was to quantify revision for any reason, mechanical failure, aseptic loosening, polyethylene wear, reoperation, and any infection after total knee arthroplasty using BMI, body surface area, body mass, and height as continuous variables.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Prospectively collected data from a single institution\u2019s total joint registry were used to analyze 22,243 consecutive knees, in 16,106 patients, treated with a primary total knee arthroplasty from 1985 to 2012. The Kaplan-Meier survival method was used to evaluate revision and other common complications, with outcomes assessed using Cox regression analysis. Smoothing spline parameterization was used on physical parameters in these models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Increasing BMI, body surface area, body mass, and height were associated with an increased risk of any revision surgical procedure, mechanical failure, and aseptic loosening after total knee arthroplasty. The risk of a revision surgical procedure was directly associated with each 1 standard deviation increase in BMI (hazard ratio [HR], 1.19; p &lt; 0.01), body surface area (HR, 1.37; p &lt; 0.01), body mass (HR, 1.30; p &lt; 0.01), and height (HR, 1.22; p &lt; 0.01). This association was especially demonstrated with revision for mechanical failure (BMI: HR, 1.15; p &lt; 0.01; body surface area: HR, 1.35; p &lt; 0.01; body mass: HR, 1.27; p &lt; 0.01; and height: HR, 1.23; p &lt; 0.01). The risk of failure in the subgroups of mechanical failure including a revision surgical procedure for aseptic loosening or polyethylene wear was also associated with increasing body surface area, body mass, and height. Increasing BMI (HR, 1.22; p &lt; 0.01), body surface area (HR, 2.56; p &lt; 0.01), and body mass (HR, 2.54; p &lt; 0.01) were also associated with increased risk of any infection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Increasing BMI, body surface area, body mass, and height were strongly associated with the rates of revision, aseptic loosening, and other common complications following total knee arthroplasty. Body surface area and body mass appear to correlate more strongly with mechanical failure outcomes than BMI or height.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Prognostic\n                      <jats:underline>Level IV<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.18.00248","type":"journal-article","created":{"date-parts":[[2018,11,7]],"date-time":"2018-11-07T15:43:59Z","timestamp":1541605439000},"page":"1829-1837","source":"Crossref","is-referenced-by-count":34,"title":["Effect of Physical Parameters on Outcomes of Total Knee Arthroplasty"],"prefix":"10.2106","volume":"100","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2351-8318","authenticated-orcid":false,"given":"Tyson C.","family":"Christensen","sequence":"first","affiliation":[{"name":"Departments of Orthopedic Surgery (T.C.C., E.R.W., and D.J.B.) and Biostatistics and Health Sciences Research (W.S.H. and C.D.S.), Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9241-5702","authenticated-orcid":false,"given":"Eric R.","family":"Wagner","sequence":"additional","affiliation":[{"name":"Departments of Orthopedic Surgery (T.C.C., E.R.W., and D.J.B.) and Biostatistics and Health Sciences Research (W.S.H. and C.D.S.), Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7134-5362","authenticated-orcid":false,"given":"William S.","family":"Harmsen","sequence":"additional","affiliation":[{"name":"Departments of Orthopedic Surgery (T.C.C., E.R.W., and D.J.B.) and Biostatistics and Health Sciences Research (W.S.H. and C.D.S.), Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0419-1946","authenticated-orcid":false,"given":"Cathy D.","family":"Schleck","sequence":"additional","affiliation":[{"name":"Departments of Orthopedic Surgery (T.C.C., E.R.W., and D.J.B.) and Biostatistics and Health Sciences Research (W.S.H. and C.D.S.), Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1422-0306","authenticated-orcid":false,"given":"Daniel J.","family":"Berry","sequence":"additional","affiliation":[{"name":"Departments of Orthopedic Surgery (T.C.C., E.R.W., and D.J.B.) and Biostatistics and Health Sciences Research (W.S.H. and C.D.S.), Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2018,11,7]]},"reference":[{"issue":"9945","key":"bib1-20230810","doi-asserted-by":"crossref","first-page":"766","DOI":"10.1016\/S0140-6736(14)60460-8","article-title":"Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013","volume":"384","author":"Ng","year":"2014","journal-title":"Lancet."},{"issue":"11","key":"bib2-20230810","doi-asserted-by":"crossref","first-page":"1138","DOI":"10.1056\/NEJMsr043743","article-title":"A potential decline in life expectancy in the United States in the 21st century","volume":"352","author":"Olshansky","year":"2005","journal-title":"N Engl J Med."},{"issue":"3","key":"bib3-20230810","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1016\/S0895-4356(99)00162-6","article-title":"Obesity, overweight and patterns of osteoarthritis: the Ulm Osteoarthritis Study","volume":"53","author":"St\u00fcrmer","year":"2000","journal-title":"J Clin Epidemiol."},{"issue":"1","key":"bib4-20230810","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1093\/oxfordjournals.aje.a114939","article-title":"Factors associated with osteoarthritis of the knee in the first national Health and Nutrition Examination Survey (HANES I). 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