{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:25:35Z","timestamp":1790209535161,"version":"4.1.0"},"reference-count":31,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T00:00:00Z","timestamp":1766448000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Osteoarthritis (OA) is a prevalent degenerative joint disease and a major cause of disability in the aging population. Total knee arthroplasty (TKA) is a common intervention for advanced OA, yet postoperative outcomes may vary, particularly among individuals with obesity. Elevated body mass index (BMI) is a recognized risk factor for the development and progression of OA and may influence perioperative and postoperative complication rates. Objective: This literature review evaluates whether a specific BMI threshold should guide eligibility for primary TKA, with particular emphasis on the impact of BMI on surgical risk, implant outcomes, and functional recovery. Methods: A systematic search was conducted across PubMed (MEDLINE), Cochrane Library, EMBASE, and Google Scholar to identify peer-reviewed studies from the past two decades examining the relationship between BMI and clinical outcomes following primary TKA. Findings: Higher BMI\u2014especially \u226540 kg\/m2\u2014is consistently associated with increased perioperative and postoperative complications, including wound issues, infection, thromboembolic events, longer hospital stay, and higher revision risk. Despite these elevated risks, evidence demonstrates that obese and morbidly obese patients experience substantial improvements in pain, mobility, and function that are comparable in magnitude to those seen in non-obese individuals. The literature does not support a universally applicable BMI cutoff for determining surgical eligibility. Conclusions: BMI is an important modifier of surgical risk but should not be used as an absolute criterion for excluding patients from TKA. Instead, a personalized approach is recommended\u2014one that considers BMI within the context of comorbidities, functional limitation, patient motivation, and opportunities for preoperative optimization. With appropriate patient selection and risk-mitigation strategies, TKA remains a clinically valuable and justified intervention across all BMI categories.<\/jats:p>","DOI":"10.3390\/jcm15010103","type":"journal-article","created":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T14:05:22Z","timestamp":1766498722000},"page":"103","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Is There a Body Mass Index Threshold for Patients Undergoing Primary Total Knee Replacement\u2014A Literature Review"],"prefix":"10.3390","volume":"15","author":[{"given":"Muhammad","family":"Kamran","sequence":"first","affiliation":[{"name":"Senior House Officer Orthopaedics & Trauma Surgery, OLHN, MBBS, C15 RK7Y Navan, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahmoud","family":"Abumarzouq","sequence":"additional","affiliation":[{"name":"Registrar Orthopedics & Trauma Surgery, OLHN, C15 RK7Y Navan, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anant","family":"Mahapatra","sequence":"additional","affiliation":[{"name":"Consultant Orthopedics & Trauma Surgery, OLHN, OLOL Drogheda Ms (Orth), FRCS, MCh (Orth), FRCS (Orth), FFSEM, FIOA, C15 RK7Y Navan, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1016\/j.maturitas.2013.03.005","article-title":"Knee Replacement for Osteoarthritis","volume":"75","author":"Liddle","year":"2013","journal-title":"Maturitas"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Karpi\u0144ski, R., Prus, A., Baj, J., Radej, S., Prz\u0105dka, M., Krakowski, P., and Jonak, K. (2025). Articular Cartilage: Structure, Biomechanics, and the Potential of Conventional and Advanced Diagnostics. Appl. Sci., 15.","DOI":"10.3390\/app15126896"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/j.knee.2006.11.004","article-title":"Obesity and Knee Arthroplasty","volume":"14","author":"Gillespie","year":"2007","journal-title":"Knee"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1097\/00003677-200510000-00008","article-title":"The Role of Mechanical Loading in the Onset and Progression of Osteoarthritis","volume":"33","author":"Griffin","year":"2005","journal-title":"Exerc. Sport Sci. Rev."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Grotle, M., Hagen, K.B., Natvig, B., Dahl, F.A., and Kvien, T.K. (2008). Obesity and Osteoarthritis in Knee, Hip and\/or Hand: A Population Study with 10-Year Follow-Up. BMC Musculoskelet. Disord., 9.","DOI":"10.1186\/1471-2474-9-132"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1016\/j.jcot.2018.04.007","article-title":"Obesity and racial characteristics drive utilization of total joint arthroplasty at a younger age","volume":"10","author":"Brock","year":"2019","journal-title":"J. Clin. Orthop. Trauma"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e39","DOI":"10.1002\/bjs.11447","article-title":"Perioperative Care of Obese Patients","volume":"107","author":"Carron","year":"2020","journal-title":"Br. J. Surg."},{"key":"ref_9","first-page":"36","article-title":"Risk Factors for Infection in Total Knee Arthroplasty","volume":"59","year":"2015","journal-title":"Rev. Esp. Cir. Ortop. Traumatol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1839","DOI":"10.2106\/JBJS.K.00820","article-title":"The Influence of Obesity on the Complication Rate and Outcome of Total Knee Arthroplasty","volume":"94","author":"Kerkhoffs","year":"2012","journal-title":"J. Bone Joint Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1016\/j.knee.2017.02.005","article-title":"Preoperative Body Mass Index and Physical Function Are Associated with Length of Stay and Facility Discharge After Total Knee Arthroplasty","volume":"24","author":"Prohaska","year":"2017","journal-title":"Knee"},{"key":"ref_12","first-page":"169","article-title":"Effect of Body Mass Index on Complications and Reoperations After Total Hip Arthroplasty","volume":"98","author":"Wagner","year":"2016","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Baghbani-Naghadehi, F., Armijo-Olivo, S., Prado, C.M., Gramlich, L., and Woodhouse, L.J. (2022). Does obesity affect patient-reported outcomes following total knee arthroplasty?. BMC Musculoskelet. Disord., 23.","DOI":"10.1186\/s12891-022-04997-4"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1308\/rcsann.2016.0103","article-title":"Hip and Knee Arthroplasty Implants Contraindicated in Obesity","volume":"98","author":"Creighton","year":"2016","journal-title":"Ann. R. Coll. Surg. Engl."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2259","DOI":"10.1007\/s00167-018-5218-6","article-title":"Obesity Should Not Be Considered a Contraindication to Medial Oxford UKA: Long-Term Outcomes in 1000 Knees","volume":"27","author":"Molloy","year":"2019","journal-title":"Knee Surg. Sports Traumatol. Arthrosc."},{"key":"ref_16","first-page":"e46203","article-title":"Increase in Postoperative BMI in Patients After Total Knee Arthroplasty","volume":"15","author":"Barahona","year":"2023","journal-title":"Cureus"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"918","DOI":"10.1016\/j.joca.2014.04.013","article-title":"The Effect of BMI on Postoperative Complications After THR or TKR","volume":"22","author":"Wallace","year":"2014","journal-title":"Osteoarthr. Cartil."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"856","DOI":"10.1016\/j.arth.2017.09.067","article-title":"Postoperative Complications of Total Joint Arthroplasty in Obese Patients Stratified by BMI","volume":"33","author":"Zusmanovich","year":"2018","journal-title":"J. Arthroplasty"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1672","DOI":"10.1016\/S0140-6736(18)32344-4","article-title":"Knee Replacement","volume":"392","author":"Price","year":"2018","journal-title":"Lancet"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1183","DOI":"10.2106\/JBJS.16.00960","article-title":"Functional Gain and Pain Relief After Total Joint Replacement According to Obesity Status","volume":"99","author":"Li","year":"2017","journal-title":"J. Bone Joint Surg."},{"key":"ref_21","unstructured":"American Academy of Orthopaedic Surgeons (2024, September 29). Preoperative Risk Factors. Available online: https:\/\/www.aaos.org\/quality\/quality-programs\/quality-toolkits\/obesity\/."},{"key":"ref_22","unstructured":"Cheshire and Merseyside NHS (2024, September 29). Hip and Knee Replacement Policy. Available online: https:\/\/www.cheshireandmerseyside.nhs.uk\/media\/smrhlppb\/pol-clin084-hipkneereplace-v1-final.pdf."},{"key":"ref_23","unstructured":"Mayo Clinic (2024, September 29). Obesity and Total Joint Arthroplasty. Available online: https:\/\/www.mayoclinic.org\/medical-professionals\/orthopedic-surgery\/news\/obesity-and-total-joint-arthroplasty\/mac-20537669."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"S369","DOI":"10.1016\/j.joca.2020.02.577","article-title":"Pre-Operative Predictors of Composite Net Benefit After TKA","volume":"28","author":"Hawker","year":"2020","journal-title":"Osteoarthr. Cartil."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1007\/s12178-017-9409-4","article-title":"Shared Decision Making in Orthopedic Surgery","volume":"10","author":"Klifto","year":"2017","journal-title":"Curr. Rev. Musculoskelet. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"578","DOI":"10.1111\/obr.12173","article-title":"Osteoarthritis, Obesity and Weight Loss","volume":"15","author":"Bliddal","year":"2014","journal-title":"Obes. Rev."},{"key":"ref_27","first-page":"jrheum.2023-0819","article-title":"Physical Activity and Weight Management in Knee and Hip OA","volume":"51","author":"Huffman","year":"2023","journal-title":"J. Rheumatol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1007\/s00402-019-03127-5","article-title":"Outcomes of TKA in Morbidly Obese Patients","volume":"139","author":"Boyce","year":"2019","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1007\/s11999-009-1119-9","article-title":"Patient Satisfaction After Total Knee Arthroplasty","volume":"468","author":"Bourne","year":"2010","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1609","DOI":"10.2106\/00004623-200408000-00002","article-title":"The Outcome of Total Knee Arthroplasty in Obese Patients","volume":"86","author":"Foran","year":"2014","journal-title":"J. Bone Jt. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1016\/j.artd.2022.07.016","article-title":"Techniques to Reduce Arthroplasty Complications in Morbidly Obese Patients","volume":"17","author":"Rankin","year":"2022","journal-title":"Arthroplast. Today"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/1\/103\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,26]],"date-time":"2025-12-26T05:13:31Z","timestamp":1766726011000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/1\/103"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,23]]},"references-count":31,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["jcm15010103"],"URL":"https:\/\/doi.org\/10.3390\/jcm15010103","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,23]]}}}