Is There a Body Mass Index Threshold for Patients Undergoing Primary Total Knee Replacement-A Literature Review

Area of Science:

• Orthopedics
• Geriatric Medicine
• Public Health

Background:

• Osteoarthritis (OA) is a leading cause of disability in aging populations.
• Total knee arthroplasty (TKA) is a common treatment for advanced OA.
• Obesity, indicated by elevated Body Mass Index (BMI), is linked to OA development and impacts TKA outcomes.

Purpose of the Study:

• To review literature on whether a specific BMI threshold should determine eligibility for primary TKA.
• To assess the influence of BMI on surgical risks, implant success, and functional recovery after TKA.

Main Methods:

• Systematic literature search of PubMed, Cochrane Library, EMBASE, and Google Scholar.
• Included peer-reviewed studies from the last two decades.
• Focused on the relationship between BMI and clinical outcomes in primary TKA.

Main Results:

• Higher BMI (especially ≥40 kg/m²) correlates with increased perioperative/postoperative complications (wound issues, infection, thromboembolism, longer hospital stays, higher revision rates).
• Obese and morbidly obese patients show significant functional improvements comparable to non-obese individuals post-TKA.
• No universal BMI cutoff is supported by current literature for TKA eligibility.

Conclusions:

• BMI is a significant factor in surgical risk but not an absolute exclusion criterion for TKA.
• A personalized approach is recommended, considering BMI alongside comorbidities, functional status, and preoperative optimization.
• TKA is a valuable intervention across all BMI categories with appropriate patient selection and risk management.